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2. Citizen Commendation and Complaint Form
4. First Name:*
5. Last Name:*
6. Birth Date:*
   Birth Date:
8. Address 1*
10. Address 2
12. City*
13. State*
14. Zip*
16. Home Phone: *
17. Cell Phone:*
19. Officer's Name:*
20. Case #:
22. Please Choose:*
    -- Select One --CommendationComplaint
23. Brief Reason for Submission:*

    Please write a brief description for your submission today.

25. Please Provide Details:*
27. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I Agree
29. Signature:*
30. Today's Date:*
    Today's Date:
32. ***Notice for Complaints***

    I understand that if I deliberately make false statements in this report or to any officer investigating my complaint, that I have committed a criminal offense and can be prosecuted for such statements, whether those statements were verbal or written, pursuant to Utah law UCA 76-8-504 ( giving false information ) and Utah law UCA 76-8-606 ( making a false report).

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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

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