Citizen Review Board - Complaint Form

Las Vegas Metropolitan Police Department (LVMPD)

Citizen Review Board (CRB) Complaint Form

Required Fields Are Marked With An Asterisk: *

INSTRUCTIONS

Please complete all 3 pages of this form. Each person filing a Complaint must complete a separate form. You may submit this complaint online, mail the Complaint to: Citizen Review Board, 330 S. Third Street, Suite 670, Las Vegas, NV 89101, or send by email to: CRBInfo@ClarkCountyNV.gov . If you are in custody, you may submit the completed form to a corrections officer.

YOUR INFORMATION

Title:

Mr.

Ms.

Mx.

Last Name:

First Name:

Middle Name:

*	Date of Birth:			Race/Ethnicity:			*	SSN (Final Four Digits):
		MM/DD/YYYY

Telephone Number:

E-Mail Address:

Inmate ID No.:

Home Address:

City:

State:

Zip Code:

IF IN CUSTODY, PROVIDE NAME OF FACILITY AND ADDRESS

	Mailing Address:			City:			State:			Zip Code:
		IF DIFFERENT FROM HOME ADDRESS

INCIDENT INFORMATION

*	Date of Incident:			Time of Incident (If known):
		MM/DD/YYYY

Location of Incident:

Name & Badge # of Accused Officer(s):

Please Go To Next Page

* DESCRIPTION OF INCIDENT

In the space below, please state in exact detail what occurred that causes you to believe that police officer(s) engaged in misconduct. In your description, include the names of all officers who engaged in the alleged misconduct, witnesses who observed the incident, and all other facts relevant to the review of this incident. Attach any reports, photographs or other material you would like the Citizen Review Board to consider.

(Attach additional sheets as needed and sign the bottom of each additional page)

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.

Please Go To Next Page

AUTHORIZATION

I HEREBY AUTHORIZE the Citizen Review Board to review the conduct alleged in this Complaint and take appropriate action as authorized by law. I hereby state under the penalty of perjury that all information provided in this Complaint is true and correct. I understand that these proceedings are confidential as provided by law. By signing this document, I authorize the Las Vegas Metropolitan Police Department to provide the Citizen Review Board with all unredacted reports and records relevant to the conduct alleged in the Complaint, which may include confidential information, personally identifiable information, and/or records of my criminal history.

*	Print Name/Signature:

*	Date:
	MM/DD/YYYY

Click "Submit" to send your complaint to the Citizen Review Board

FOR CITIZEN REVIEW BOARD USE ONLY

Date Received:

Case No.:

Allegations: