HAWAII POLICE DEPARTMENT
Internal Affairs Unit
Written Complaint
YOUR NAME: __________________________________________ DATE: __________________
ADDRESS: _______________________________________ PHONE: ______________________
LOCATION OF INCIDENT: ________________________________________________________
DATE OF INCIDENT: _________________________ TIME OF INCIDENT: _________________
ACCUSED EMPLOYEE: _________________________________________ BADGE NO. ________
STATEMENT OF COMPLAINT
Subscribed and sworn to before me
This _______ day of _______, 20______ Signed: _____________________________
Date: _______________ Time: __________
Notary Public, Third Judicial Circuit
State of
My Commission Expires: _____________