You may use this form just as if you had picked it up

at the Sheriff's office or were phoning in a report.

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Please fill out form as completely as possible.

IMPORTANT: Use "Tab" key to move from field to field.

If you use "Enter" you will Submit the form and have to start over.

(scroll down for complete form)

    Complaint Reported By: 

Name:        Date Of Birth:        Home Phone:   

Address:        City:   

State:        Zip:        County:   

Hours available:   

Place of Employment:        Work Phone:   

Address (Employer):        City:   

State:        Zip:        County:   

    Complaint Reported Against: 

Name:        Date Of Birth:        Home Phone:   

Address:        City:   

State:        Zip:        County:   

Place of Employment:        Position:   

Address (Employer):        City:   

State:        Zip:        County:   

    Witness(s):

Name:                                                 Home Phone:   

Address:           Work Phone:   

Name:                                                 Home Phone:   

Address:           Work Phone:   

Have you filed reports with any other agency:    Yes        No

If "Yes" Explain:

Has any action been taken against YOU in this matter?:    Yes   No 

If "Yes Explain:

Please describe, below, the facts which have contributed to the filing of this complaint.  Include dates and locations of all pertinent events.

This complaint will be forwarded to the Phelps County Sheriff's Office when you press the "Submit" button at the end of this form.

By entering my Full Name below I state that the information given above, is, to the best of my knowledge, true and complete.  I authorize the Phelps County Sheriff to use this information in any manner determined to be necessary.   

Full Name:   

Double check information included above and click  Submit  below, or press  Enter  when ready to send this form.......Thank You