CARROLL COUNTY POLICE ACCOUNTABILITY BOARD POLICE MISCONDUCT COMPLAINT FORM

CARROLL COUNTY POLICE ACCOUNTABILITY BOARD POLICE MISCONDUCT COMPLAINT FORM
This form is to be used for complaints of police misconduct occurring in Carroll County, Maryland, after June 30, 2022. Please contact the law enforcement agency directly for instructions on filing complaints of police misconduct occurring prior to July 1, 2022. Each complaint of police misconduct filed with the Carroll County Police Accountability Board (PAB) shall be forwarded to the appropriate law enforcement agency by the PAB within three days of receipt. The law enforcement agency is responsible for completing an investigation of the complaint. The disposition of a complaint shall be completed within 1 year and 1 day of the filing of a complaint.

Incomplete or unsigned forms may not be processed. Return this completed and signed form by mail or in-person to:

Carroll County Police Accountability Board c/o Office of the County Attorney 225 N. Center Street, Room 300 Westminster, MD 21157
Name of Complainant: *

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Contact Information of Complainant*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Name of Person Completing this Form, if other than the Complainant:

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Incident Information
Describe the encounter or incident which is the basis of the complaint? (street address or description of location with as much as detail as possible)?*
On what date and what time did the incident that you are complaining about occur?

MonthDayYear
Date
Time of incident

Hour Minutes

AM/PM Option
List the Name(s) of the Officer(s) involved if you know them:
Include name, ID #, and agency if possible
If the Name(s) of the Officer(s) is unknown to you, please list any identifying information that you know (car number, physical description, etc.)
List the name, address, and phone number of any witness(es) to the incident
What is you complaint? Please describe what happened in your own words.(Write in a word document and upload the document if needed)
Attach any additional information

Cancelof
Should be Empty:

CARROLL COUNTY POLICE ACCOUNTABILITY BOARD POLICE MISCONDUCT COMPLAINT FORM

Incident Information