Las Vegas Metropolitan Police Department (LVMPD)
Required Fields Are Marked With An Asterisk: *
COMPLAINANT INFORMATION
* Title:
* Complainant Name:
* Contact Mailing Address:
* City: * State: * Zip:
E-Mail Address (Optional):
* Contact Phone # (Home):
* Contact Phone # (Work):
Ethnicity (Optional): * DOB:
MM/DD/YYYY
* Last Four Digits of Social Security Number:
If in custody, Facility and Inmate ID #:
Out of Custody Address & Phone:
INCIDENT INFORMATION
Location of Incident:
* Date of Incident: Time of Incident (If known):
MM/DD/YYYY
Name & Badge # of Accused Officer(s):
STATEMENT OF COMPLAINT
Please state in exact detail what occurred, names of all witnesses and police officers who observed the incident, name(s) of officers who engaged in alleged misconduct and what misconduct occurred, what injuries, if any, you suffered and all other facts related to the incident. Do not include unsubstantiated information, such as gossip or rumor. Attach any reports or documentation, such as photographs, medical or police reports, etc. which relate to the incident. You may submit this complaint online or it may be mailed, faxed, or emailed to: Office of the Executive Director, Citizen Review Board, 330 S. Third Street, Suite 670, Las Vegas, NV 89101, fax number 702-382-7426, email CRBInfo@ClarkCountyNV.gov
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* DESCRIPTION OF INCIDENT
(Attach additional sheets as needed and sign the bottom of each additional page.)
Specify any personal information you want redacted from information provided to the subject officer.
Please attach any documents relating to your complaint. You may attach up to 3 documents.
Files must be in one of the following formats: .doc, .docx, .txt, .rtf, .wpd, .wps, .pdf
Note: There is a 5 MB file size limit for each attached file and a total file size limit of 30 MB.
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SWORN STATEMENT OF COMPLAINANT
I HEREBY REQUEST the Board investigate the conduct alleged in this complaint and take appropriate action, as authorized by law. I hereby state under penalty of perjury that I am the complainant in this complaint, that I have prepared, read, and fully understand all matters set forth in this complaint, that these proceedings are confidential as provided by law and that all information provided in this complaint is true and correct. (Please be advised that by signing this document you waive privacy and confidentiality in regards to records of criminal history and such other information as is necessary to verify the allegations of your complaint.) The information being requested on this form is to enable us to collect all background information and reports necessary to make a determination on the complaint.
* Print Name/Signature:
* Date:
MM/DD/YYYY
Click "Submit" to send your complaint to the Citizen Review Board
CITIZEN REVIEW BOARD USE ONLY
Date Received:  
Case No.:  
Allegations:  
Status: