South Bend Police Department Community Complaint Form

SBPD Community Complaint Form
Is this about a South Bend Police Department employee?*

YesNo
This form is for complaints about SBPD employees. If this is another kind of complaint, please visit the citizens online police reporting page.
Name of complainant*

First NameLast Name
Name of person filing report (if different)

First NameLast Name
Are you a South Bend resident? (You do not have to be a South Bend resident to file a complaint)*

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Gender
Race
Date of Birth

MonthDayYear
Date
Date of Incident*

MonthDayYear
Date
Time of Incident*

Hour Minutes

AM/PM Option
Location of Incident*
Officer(s) Involved*
SBPD Car Number (if known)
Incident/Case Number (if applicable)
Witness Name (if applicable)
Witness Phone (if applicable)
Witness Address
Please Describe the Incident in More Detail*
How would you like to see this complaint resolved?
PLEASE NOTE: It is a criminal offense in the State of Indiana to report a complaint against a law enforcement officer if you know the complaint to be false. The South Bend Police Department takes complaints very seriously and if you make a complaint that you know to be false, you can be prosecuted pursuant to Ind. Code 35-44.1-2-3(d)(5) False reporting or informing.
I have read the above statement and affirm that the officer complaint I am reporting with this form is true and accurate to the best of my knowledge and belief. I also understand that if the complaint was knowingly falsified, I may be prosecuted under Indiana criminal law. Choosing “I do not agree” below will prevent the submission of this complaint.*

I agreeI do not agree
Please read the City of South Bend's data collection policy.
Do you agree to the City of South Bend's data collection policy?*

YesNo
Please verify that you are human*
Should be Empty:

SBPD Community Complaint Form