Fillable Printable Police Complaint Form - State University of New York

Police Complaint Form - State University of New York

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