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Middletown Police Department Civilian Complaint form

  1. Put down as much information as possible: Name, Rank Badge #, Cruiser # etc
  2. Name address, contact information
  3. To your knowledge, was all or any part of the incident complained of video or audio taped by anyone?
  4. Are you afraid for your safety, or that of any other person, for any reason as a result of making this complaint?
  5. Has anyone threatened you or otherwise tried to intimidate you in an effort to prevent you from making this complaint?
  6. Are you able to read, write and speak the English Language?
  7. If your answer to question #4 is "No" or "Unsure", have you been provided with adequate language assistance to help you understand and fill out this form?
  8. (If you answered "Yes" to any of the questions above, please provide details below) Details of the incident: Please Provide a full description of the circumstances that prompted your complaint. Attach supporting documentation, as appropriate; including letters, e-mails, photographs, and video or audio recordings.
  9. Civilian Complaints can be submitted anonymously. Complainant information is helpful for investigative purposes but not required.
  10. Leave This Blank:

  11. This field is not part of the form submission.