PERA | Civilian Complaint Language: PERA Homepage Name of complainant: Address: Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone:Email: Name and Phone of Attorney (if represented): Incident Date: MM slash DD slash YYYY Incident Time: : Hours Minutes AM PM AM/PM Incident Location: Please list any and all police officers involved in incident:To add additional officers, click on the + symbol (on the right of Description field).Name:Federal ID No.:Description Please list any and all civilian witness(es):To add additional witness(es), click on the + symbol (on the right of Email field).Name:Phone Number:Address:Email: Please describe your complaint:Be as specific as possible.
