Complaint Form

Citizen Complaint Form

Instructions

The Atlanta Citizen Review Board (ACRB) accepts complaints against officers of the Atlanta Police Department (APD) and the Atlanta Department of Corrections (ADC).

By law, the following are the only types of complaints the ACRB is authorized to review: (1) abusive language; (2) false arrest; (3) false imprisonment; (4) harassment; (5) use of excessive force; (6) serious bodily injury; or (7) death which is alleged to be the result of the actions of a sworn employee of the APD or ADC.
Your complaint will be reviewed and classified by the Executive Director of the ACRB. You will receive an acknowledgement by mail of the receipt of your complaint. If the incident is investigated, you may be asked to provide a more complete statement under oath.
IMPORTANT: Fill in this form COMPLETELY. You must PRINT or TYPE all your answers.
IF YOU NEED HELP filling out this form, please call us at 404.865.8622, or e-mail us at acrb@atlantaga.gov.

This electronic form will go directly to the ACRB for review. The required data must be completed to submit the complaint form. You will receive a confirmation after you submit the form and you will be contacted by a member of the ACRB.

Download the PDF Form here

Complainant Information

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip:

Phone:

(

)

Cell:

(

)

Work:

(

)

E-mail:

*Verify E-mail:

Employer:

Date of Birth: (mm/dd/yyyy)

Age:

Gender:

Male

Female

Race:

	African American
	Asian
	Hispanic
	White
	Other:

Incident Information
(all fields must be filled in)

*Incident Date:

*Incident Time:

*Incident Location:

*Name of Officer(s) Involved:

*Badge Number(s) of Officer(s) Involved:

*If you do not know the name or badge number of the officer(s),
please provide a physical description of the officer(s).

*Officer(s) Employed by:

	Atlanta Police Department
	Atlanta Department of Corrections

*Name(s) of Witness(es) to Incident:

*Contact Information of Witness(es) to Incident:

*Is there any evidence available about the incident,
such as copies of traffic tickets, police reports,
photographs, or medical records?

Yes

If â�œYes,â�� please describe:

*Please describe your complaint.

I solemnly swear or affirm that the above statement is accurate.

*Date:

*Signature of Complaining Party:

Atlanta Citizen Review Board â�¢ City Hall Tower, Suite 9100 â�¢ 55 Trinity Avenue S.W. â�¢ Atlanta, Georgia 30303
tel 404.865.8628 fax 404.494.1520