2. 
   

   INTERNAL AFFAIRS REPORT FORM

   City of Long Branch Police Department

   Appendix B-English

4. Person Making Report

   (Optional, But Helpful)

6. Name
7. Address
9. Phone Number
10. City
12. Email Address
13. State
15. Date of Birth
16. Preferred Contact

    1. Phone
    2. Email

18. Officer(s) Subject to Allegation (Provide Whatever Info Is Known)

20. Officer(s)
21. Badge #
23. Incident Site
24. Date & Time
26. Description of Incident

    Describe the type of incident (traffic stop, street encounter) and any information about the alleged conduct. If you cannot fit your response below, feel free to use extra pages and attach them to this document. If you do not know the officer’s name or badge number, provide any other identifying information.

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field