Please provide your contact information.
Please provide contact information for any witnesses.
Please provide the names of the officer(s) or employee(s) involved.
Please provide information regarding the incident.
By signing this form, I acknowledge that the information I’ve provided is true and correct to the best of my knowledge. I understand that it is a criminal offense to make a false statement to a member of the police department, pursuant section 76-8-503 and/or 76-8-504, of the Utah Criminal Code. I understand that digital signatures are considered legal in the State of Utah.
This field is not part of the form submission.
* indicates a required field