Complaint Against Police Personnel Name of Office/EmployeeIf you don't know the name please give a brief description.Complainant’s NameResidence AddressResidence PhoneEmploymentBusiness PhoneWitnessesName/Residence Address/Residence Phone/Employer/Business PhoneDate of Incident Time Of Incident : HH MM AMPM NOTE: (1) Complaints alleging brutality must be sworn to within 90 days of the incident by the aggrievedperson, a member of the aggrieved person’s immediate family, or by any person with firsthand knowledgeobtained as a result of the presence at and observation of the incident, or by the parent or guardian in the caseof a minor child, before an official authorized to administer oaths. (2) Any person who knowingly makes afalse statement, report or complaint in the course of an investigation is subject to, upon conviction, a $500 fineand/or six months imprisonment. (Reference: Annotated Code of Maryland, Article 27, Sections 728 & 734c.)Section BreakINameBeingYears of AgePlease enter a value between 1 and 120.Residing atAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code do hereby swear or affirm that theinformation stated herein is true and correct to the best of my knowledge and belief. I furtherunderstand that all information sworn to as true and correct proven to be false could be causefor criminal charges, a civil liability suit or the dismissal of this complaint.Complaint ObservationsThis complaint is based on the following factual information or observations.Digital SignaturePlease type your name above, acting as your digital signature.