Personal Information

First Name:*

Last Name:*

Email Address:*

Home Phone#:

Additional Phone#:

Information about your arrest/incarceration:(if applicable)

Date of Incident:*

Time of release:

Location of Incident:*

Date(s) of Current Incarceration:

Were you arrested by:*

County Sheriff Officers City Police Officers

Other N/A

If you were arrested, other than personal information, were you questioned about the incident?:

Yes

No

If so, were you read your Miranda Rights?

Yes

No

Given the right to speak to an attorney?

Yes

No

Given an interpreter if you needed one?

Yes No

Did not have a need for one

Do you feel you were physically mistreated while being arrested?

Yes

No

If Yes, explain:

Do you feel you were verbally mistreated while being arrested?

Yes

No

If Yes, explain:

Information About the Incident

Witness Name & Phone#:

Officer(s) Involved (if you do not have name(s), a description is helpful):*

Describe what happened:*

How do you wish to be contacted:*

by Email by Phone

Do Not Contact Me

I have read and understand this complaint and find it true and correct. It is my desire that this complaint be fully investigated. I further understand that if the investigation proves the allegation(s) to be false, I may be liable to both criminal and civil prosecution pursuant to the City of Pueblo's False Reporting Ordinance Sec 11-1-504. *

I Agree