Citizen's Complaint Form

University of California Police Department, Berkeley

Incident Date: ___________ Time: ____________
Location: ________________________________
Allegations (list): ____________________________________________________
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You have the right to make a complaint against a police officer for any improper police conduct. California law requires this agency to have a procedure to investigate citizens' complaints. You have a right to a written description of this procedure. This agency may find after investigation that there is not enough evidence to warrant action on your complaint; even if that is the case, you have the right to make the complaint and have it investigated if you believe an officer behaved improperly. Citizen complaints and any reports or findings relating to complaints must be retained by this agency for at least five years.

It is against the law to make a complaint that you know to be false. If you make a complaint against an officer knowing that it is false, you can be prosecuted on a misdemeanor charge (§148.6 PC).

I have read and understood the above statement. I understand that I am making a formal complaint, that an investigator will be assigned and that I will be contacted and interviewed. I agree to cooperate fully with the investigation. I understand that if I do not return this form as instructed this complaint will be closed.

I hereby certify that, to the best of my knowledge, the statements herein are true.

________________________________________ _____________
Signature of Complainant ....................................... Date

Name (Print): ____________________________________________________
Address: ________________________________________________________
________________________________________________________________
Day Phone: (_____)_______________ Night Phone: (_____)_______________

Witnesses and Other People Involved:
Name (Print): ________________________
Address: ____________________________
___________________________________
Phone: (_____)_______________________

Name (Print): ________________________
Address: ____________________________
___________________________________
Phone: (_____)_______________________
Note: Complaint must be filed within thirty (30) days of the incident.

See Complaint Process Guide for more information and exceptions

 Describe incident in detail on attached sheet(s):

University of California Police Department, Berkeley
CITIZEN'S COMPLAINT STATEMENT
Please note
: Complaints must be filed with UCPD within thirty (30) days of the incident. If not, your complaint may be considered withdrawn and processed as an "Inquiry" only.

(Please Print or Type)

Name: ___________________________

Address: _________________________

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Phone #: (_____)___________________

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Signature ................................................ Date

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Time

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