Community Police Review Board South Bend Police Department (SBPD) Complaint Form

Community Police Review Board South Bend Police Department (SBPD) Complaint Form
Please note this complaint will be shared with the South Bend Police Department.
Is this about a South Bend Police Department employee?*

YesNo
This form is for complaints about SBPD employees.
Name of person making the complaint*

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.
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)
Please describe the incident in more detail*
How would you like to see this complaint resolved?
PLEASE NOTE: It as 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: