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2. Reporting Party Information
   Please enter your information in the following fields:
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Email Address*
18. Incident Information
    Please enter the Compliment information in the following fields:
20. Date/Time of Incident*
    Date/Time of Incident

    Date/Time of Incident
22. Police Report/Incident Number
23. Police Citation Number
25. Location of Incident*
27. Employee Name*
28. Employee Badge #
30. Employee Name
31. Employee Badege #
33. Employee Name
34. Employee Badge #
36. Statement*
    Please enter all information regarding this incident.
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

* indicates a required field