Complaint Form On-Line Citizen Complaint Against Officer Officer Involved: Report Number: Date of Incident: Time of Incident: Location of Incident: City ST ZIP: Complainant: Telephone: Your Address: City ST ZIP: Driver’s License Number: DOB: Relationship to Officer Involved? Witnesses: Name Address Phone Any Prior Contacts with Officer Involved? yesno Have you ever made a complaint against a police officer before? yesno If yes, what was the complaint? What department was involved? Officer involved? Statement of Complainant: STATEMENT: A person making a false statement in their complaint shall be guilty of 2921.12 Falsification of the Ohio Revised Code. This offense is a Misdemeanor of the first degree which each violation can be punishable by up to 180 days in jail and/or a $1000 fine.