Citizen Complaint Form

Village of Mukwonago Police Department

Name of Complainant
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone Number
Name of Officer Involved
Name
Date of Incident
Date Format: MM slash DD slash YYYY
Time of Incident

: HH

MM
Location of Incident
Witness Name
First Last
Witness Address
Street Address Address Line 2 City State ZIP Code
Witness Phone Number
Statement about details of incident
Signature of Camplainant
Date
Date Format: MM slash DD slash YYYY
Notice - Wisconsin state statute 946.66 provides, "Whoever knowingly makes a false complaint regarding the conduct of a Law Enforcement Officer i.s subject to a Class A Forfeiture." A fine not to exceed $10,000 or Imprisonment, not to ex.:eed 9 months or both.