Form Center

2. 
3. WARRENVILLE POLICE DEPT.

   3S245 Warren Avenue, Warrenville, IL 60555  |  Non-Emergency (630) 393-2131  |  FAX (630) 393-4071

4. Department Member Complaint Form
6. Date of Report*
   Date of Report

   Date of Report
7. Important Notice

   It is the policy of the Warrenville Police Department to thoroughly investigate all complaints of any possible violation of the department’s Rules & Regulations and/or Polices & Procedures. This department recognizes that maintaining a professional conduct throughout the organization requires an objective, fair and honest review process that will ensure the department’s integrity and maintain public confidence.

9. Complainant First Name
10. Complainant Last Name
12. Address
14. City
15. State
16. Zip
18. Date of Birth
    Date of Birth
19. Sex
20. Phone Number
21. Work Phone Number
25. Date & Time of Incident*
    Date & Time of Incident

    Date & Time of Incident
27. Location of Incident*
29. Department Member(s) Involved*

    (List name and/or badge number if information is known.  If not known, type "UNK.")

31. Witness #1 First Name
32. Witness #1 Last Name
34. Street Address
35. Apt #
37. City
38. State
39. Zip
41. Date of Birth
    Date of Birth
42. Sex
43. Phone Number
44. Work Phone Number
46. Witness #2 First Name
47. Witness #2 Last Name
49. Street Address
50. Apt #
52. City
53. State
54. Zip
56. Date of Birth
    Date of Birth
57. Sex
58. Phone Number
59. Work Phone Number
63. Narrative*

    Please describe the incident in as much detail as possible. You may list additional witness information at the end of this narrative. 

65. Signature

    Please Read Before Signing
    I understand, and it is my desire, that this complaint be investigated diligently. I declare that the allegations contained in this complaint are true and accurate based upon my personal knowledge of the facts contained herein.

    I also understand that it is a violation of 720 ILCS 5/25-1(a)(4) to willfully make a false report. In the event the report is proven to be false, the information may be provided to the State’s Attorney for possible prosecution.

68. Notary Public

    SWORN and SUBSCRIBED to before me this 

    _______ day of _____________________, 20____.

    
    

    __________________________________________
    Notary Public

70. WARPD-00292
71. Distribution

    Original to:   File
    Copy to:  Chief of Police, Deputy Chief of Operations, Deputy Chief of Investigations & Administration, Complainant
    
    

Leave This Blank:


73. Submit Submit and Print

* indicates a required field