AYER POLICE DEPARTMENT

COMPLAINT FORM

THIS FORM SHOULD NOT BE USED TO REPORT A CRIME IN PROGRESS.

All complaints are reviewed and taken very seriously.

The Ayer Police Department deeply respects the privacy of its citizens. We will not release your name or contact information except as necessary to resolve your complaint. If you wish to file a complaint anonymously, you may leave out your name and contact information from the form below.

Today's Date

Incident Date and Time

Your Home Phone Number

Alternate Phone Number

Your Email Address

Incident Result Of

If Other, describe below

Badge Number

Gender

Male

Female

Do you want to add information for another employee?

Yes

Additional Badge Number

Additional Gender

Male

Female

Name, Addresses, and phone numbers of Witnesses, If Any

Please describe the incident

Other Comments

By checking this box I hereby certify that the information in this complaint is true and correct to the best of my knowledge and belief

Certification