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911 Complaint Form

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Birmingham Communications Department

Citizen Complaint/ Concern Form

The Birmingham Communications Department encourages you to contact us if you have a complaint, a concern, or experience a problem with 911/311 that affects you as a citizen. We ask that you complete this form immediately after the incident or problem fist occurred. A representative from the Birmingham Communications Department will contact you within twenty-four (24) business hours.

Please understand it may become necessary to disclose your identity and/or complaint, as well as to conduct a formal investigation. Should such a disclosure become necessary, it will be only to the person(s) with a need to know your identity or the details and nature of the complaint.

911 Citizen Complaint/Concern form

Complaint form for 911

Date
MM slash DD slash YYYY
Name
First Last
Phone
Incident Number
Date of Incident
MM slash DD slash YYYY
Time of Incident

: Hours

Minutes

AM/PM
Location of Indicent
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
List all Individual(s) Involved in this complaint
List any (if any) Witnesses
Nature of Complaint: Note all relevant dates, places, events, etc. pertaining to the complaint:*
I acknowledge that I have read this document and understand my obligation to provide information as needed and to cooperate fully and completely with any investigation of this complaint. Should it become necessary, I authorize the Birmingham Communications Department to disclose my identity and/or details of this complaint.
Signature
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