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Please correct the field(s) marked in red below:

If you have a specific request for action to be taken by the City, you may submit it through our Complaint Form.

Please complete the entire questionnaire. Please note, if the information you provide is incomplete or the City has questions about your request, we may not be able to fully investigate if we cannot contact you. Once we determine which department should receive you request, it will be entered into our tracking system.

Please Note: (*) indicates required fields.
1
Contact Information
 *
Contact Information
2
City Employee's Name
 *
3

City department where employee works:

4
Date of Incident:
 *
5

Time of Incident:

 *
6
Place of Incident:
 *
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Describe Incident:
 *
8
Does an attorney represent you in this matter
9

If yes, please give his/her name and address:

10
Have you begun any legal action aginst this person or department? If so, please describe:
11
Are you willing to sign an affidavit or complaint against the person you named if requested:
  1. To receive a copy of your submission, please fill out your email address below and submit.