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I want to file a:  Complaint   Commendation

Are you filing on behalf of someone else?  Yes  No
His/Her Name:    Phone: 

Are you represented by an attorney regarding this matter?  Yes  No
His/Her Name:    Phone: 

Information about you:

Last:      First:      Middle:  

Home:     Work:  

Cell:    Email:  

Date of Birth:     Gender  Male  Female       Race:  

Street:     Apt.:  

City:     State:     Zip Code: 

Information about the incident:

Date:     Time:     AM  PM

Address/Location:  

Information about the Eugene Police Dept. officer(s) or Dept. employee(s) involved:

Name:      Badge Number: 
Name:      Badge Number: 

Information about a witness:

Name:       Phone:  

Address:  

Briefly summarize what happened: