Fillable Printable Police Complaint Form - State University of New York
Fillable Printable Police Complaint Form - State University of New York
![Police Complaint Form - State University of New York](/resources/formfile/images/10000/police-complaint-form-state-university-of-new-york-page1.png)
Police Complaint Form - State University of New York
![](/resources/formfile/htmls/10000/police-complaint-form-state-university-of-new-york/bg1.png)
N E W Y O R K S T A T E U N I V E R S I T Y P O L I C E
State University of New York at Buffalo
Bissell Hall, Buffalo, New York 14260-4900
Tel: 716-645-2227 Fax: 716-645-3758
www.upolice.buffalo.edu
Gerald W. Schoenle, Chief of Police
POLICE COMPLAINT FORM
Phone In-Person E-Mail US Mail Anonymous
Complainant:
Name:
Address:
Telephone:
Business Phone:
Complaint:
Date:
Day:
Time:
Location of Complaint:
Complaint Description:
List any witness names, addresses, telephone numbers, record any evidence, injuries and damage:
FALSE STATEMENTS MADE HEREIN, ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO
SEC. 210.45 OF THE PENAL LAW. AFFIRMED UNDER PENALY OF PERJURY.
Complainant’s Signature
Date
Supervisor’s Signature
Date
Time
Rev. 12/2012