Form Center

Complainant

COMPLAINANT SECTION
This area is optional.
I would like to submit this form:*
1. Known, available for follow-up
2. Anonymously
Name
Date of Birth
Address
City
State
Zip Code
Phone Number
Email Address
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Are you making this complaint of your own free will?
1. Yes
2. No
Were you arrested as a result of this incident?
1. Yes
2. No
If yes, what charge(s)?
Are you willing to appear and give testimony under oath at a department hearing and/or criminal proceeding?
1. Yes
2. No
Complaint Narrative - State exact circumstances of the complaint:
Upload any supporting documents you may have.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) You understand that this statement of complaint will be submitted to the Geneva Police Department and may be the basis for an investigation. 2) I understand that false statements made herein are punishable as a class A misdemeanor pursuant to Section 210.45 of the Penal Law. 3) I declare that my statement has been made by me voluntarily without persuasion, coercion or promise of any kind. 4) By signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree. (if anonymous, click agree, then type anonymous in the field below)
Electronic Signature

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