Internal Affairs Complaint

Please use this form to initiate an Internal Affairs Complaint. The information you place on this form is confidential and will be transmitted directly to the IAD office for review. You may however elect to call the IAD office directly at (609) 347-5833 or visit the office located at 21 S. Tennessee Avenue, Atlantic City, New Jersey 08401.

Name
Address
City
State / Zip
Phone Number
Birth Date
Social Security #	- -
Employer/School
Work Number
Work Address
City/State/Zip
	INCIDENT INFORMATION
Accused Officer
Accused Officer
Date Occured
Time Occured
Location Occured
What Happened?
Injuries (if any)
Where Treated
Date of Treatment
Dr.'s Name
Today's Date

It is a criminal offense to provide a statement that you do not believe to be true!

Internal Affairs Section, 21 South Tennessee Avenue, Atlantic City, New Jersey, 08401