2. 
3. Report of Complaint Against Department Personnel

   Confidential

5. Name of Complainant:
7. Address:
9. City:
10. State:
11. Zip Code:
13. Phone number:
15. Rank:
16. Name:
17. Badge Number:
19. I.D. Number:
20. Vehicle:
22. Name(s), address, phone number or other identifying information concerning witness:
24. Statement of allegation:
26. Additional information:

    I understand this statement of complaint will be submitted to the Administrative Commander and may be the basis for an investigation. Further, I sincerely and truly declare and affirm the facts contained herein are complete, accurate, and true to the best of my knowledge and belief. 

    Further, I declare and affirm my statement has been made voluntarily and is not the result of persuasion, coercion, or promise of any kind. 

    I understand, under the regulations of the West Fargo Police Department, the officer against whom this complaint is filed may be entitled to request a hearing before a Board of Inquiry. By signing and submitting this complaint, I hereby agree to appear before a Board of Inquiry, if one is requested by an officer, and to testify under oath concerning all matters relevant to this complaint. 

28. Signature of Complainant:
29. Date:
    Date:

    Date:
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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