Form Center

2. The Boynton Beach Police Department is a professional law enforcement organization, which strives to provide quality service to the community. We encourage all persons to provide input regarding our efforts, whether or not the person is pleased or displeased with our performance. This information is invaluable to our review process, and we maintain these records for future reference.

4. Internal Affairs Number*
5. Nature of Complaint*
7. Date Complaint Filed*
   Date Complaint Filed
9. Complainant's Name*
11. Date of Birth*
    Date of Birth
12. Race*
13. Sex*
    -- Select One --MaleFemale
15. Address*
17. City*
18. State*
19. ZIP Code*
21. Phone (Day)*
22. Phone (Night)*
24. Date / Time of Incident*
    Date / Time of Incident

    Date / Time of Incident
26. Case Number (If Known)
28. Location of Incident*
30. Officers Involved (If Known)
32. If applicable, list other complainants and/or witnesses (also include contact number):
34. Name
35. Phone Number
37. Name
38. Phone Number
40. Name
41. Phone Number
43. Name
44. Phone Number
46. Name
47. Phone Number
49. Details of Complaint*
51. I swear or affirm the facts in this complaint to be true.*

    1. I affirm
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field