Citizens Complaint Form

Winterville Police Department P.O. Box 1459 2593 N. Railroad St. Winterville, NC 28590

Complainant Information

Complainant's Name:

Home Phone:

Address:

Work Phone:

List White Black Asian Hispanic other

Race:

Date Of Birth:

Email:

Personnel Involved

Rank:

List Patrol Officer Sergeant Detective Public Affairs Officer Office Manager Chief Master Sergeant Corporal

Personnel's Name:

List Ames Cook Dixon Easton Ervin Garcia Hurley Kelley Lymon Mercado Raby Russell Stallings Whitley Wilkes Williams

Rank:

List Patrol Officer Sergeant Detective Public Affairs Officer Office Manager Chief Master Sergeant Corporal

Personnel's Name:

List Ames Cook Dixon Easton Ervin Garcia Harris Hurley Kelley Lymon Mercado Raby Russell Stallings Whitley Wilkes Williams

List Patrol Officer Sergeant Detective Public Affairs Officer Office Manager Chief Master Sergeant Corporal

Rank:

Supervisor's Name:

List Ames Cook Dixon Easton Ervin Harris Hurley Kelley Lymon Mercado Raby Russell Stallings Whitley Wilkes Williams

Rank:

List Patrol Officer Master Sergeant Corporal Sergeant Detective Public Affairs Officer Office Manager Chief

Supervisor's Name:

List Ames Cook Dixon Easton Ervin Garcia Harris Hurley Kelley Lymon Mercado Raby Russell Stallings Whitley Wilkes Williams

Witnesses

Witness Name:

Date Of Birth:

Address:

List White Black Asian Hispanic other

Race:

Home Phone:

Work Phone:

Witness Name:

Date Of Birth:

Address:

List White Black Asian Hispanic other

Race:

Home Phone:

Work Phone:

Brief Description of the Incident

(You will be contacted for details.)

Before you submit this complaint form to the Police Department, you are stating that all of the information above is true to the best of your knowledge. Please print this form before you submit it as your copy. Thank you.