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2. 
3. Storm Lake Police Department
4. Citizen Commendation/Complaint Form*

   1. Commendation
   2. Complaint
6. Citizen's Name:*
7. Date of Birth:*
   Date of Birth:
9. Address: *
   Street ~ City ~ State ~ Zip Code
11. Email:
12. Phone Number:*
14. Officer(s) Involed:
16. 1.
17. 3.
19. 2.
20. 4.
22. Nature of Incident:*
24. Location of Incident:*
25. Date of Incident:*
    Date of Incident:

    Date of Incident:
27. Please Read Before Signing: I understand that it is a violation of Iowa Law, False Reports to Public Safety IA Code 718.6 for any person to "report or causes to be reported false information to a fire department, law enforcement authority, or other public safety entity, knowing that the information is false, or who reports the alleged occurence of a criminal act knowing the act did not occur". In the event the report is proven to be false, the information may be submitted to the Buena Vista County Attorney for possible prosecution.
29. Initials:
31. Narrative: (Please be as brief as possible).*
33. Signature:*
34. Date:*
    Date:
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

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