Durham County Sheriff's Office
Complaint Form for Citizens |
| Nature: |
OCA #: |
| Citizen's Name: |
Race & Sex: |
| Home Address: |
| City: |
State: |
Zip: |
| Home Phone: |
Business Phone: |
| Other Phone: |
| If applicable, please list other complaints and/or witnesses:
|
| Officer/Employee involved: |
Division: |
| Officer/Employee involved: |
Division: |
| Location of incident: |
| Date & Time of incident: |
| Complaint received by: |
Date: |
| Forwarded for resolution to: |
From: |
| Re-Forwarded for resolution to: |
From: |
Summary of Incident (__ Additional information attached.)
|
Resolution: (__ Additional information attached.)
|
| Citizen notified by Phone _____ Mail _____ |
| Officer submitting form to Chief Deputy: |
Date: |
