Citizen Complaint Form

The Chilhowie Police Department acknowledges its responsibility for providing a system to receive and investigate complaints from the community. No employee shall attempt to discourage, interfere, or delay an individual from making a complaint. Feedback from the community is appreciated and serves to assist us in maintaining the integrity of the agency. You will be advised in writing of the outcome of the investigation concerning your complaint. Please note that a disagreement over the validity of a traffic / vehicle code summons or parking ticket is NOT normally grounds for a complaint. The complainant shall be advised that this is a matter for adjudication by the proper court system.

Chilhowie Police Department
325 East Lee Highway
Chilhowie, Virginia
Office (276) 646-3232
Fax (276) 646-4094

CITIZEN COMPLAINT FORM

COMPLAINANT INFORMATION

Name (Last, First, M.I.)

Telephone Number

Street Address

City

State

Zip Code

WITNESS INFORMATION #1

Name (Last, First, M.I.)

Number

Street Address

City

State

Zip Code

WITNESS INFORMATION #2

Name (Last, First, M.I.)

Number

Street Address

City

State

Zip Code

COMPLAINT DETAILS

Date of Incident

Time of Incident

Location of Incident

Employee / Officer Involved (If Known)

Details of Complaint or Criticism

It is important to include as many details as possible to assist in the investigation of the incident.

By signing this form, you certify the statement above is true and accurate to the best of your knowledge and agree to appear before a board of inquiry, if the employee requests one, and to testify under oath concerning all matters relevant to this complaint.

Signature

Clear

Date

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Citizen Complaint Form