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2. Please provide your name and your contact information below.
4. First Name
5. Last Name
7. Phone Number
8. Email Address
10. Home Address
11. City
15. Please provide the name or description of the Rio Rancho Police Department employee involved in your encounter. *
17. Date and time of when this occurred. *
    Date and time of when this occurred.

    Date and time of when this occurred.
19. Did anybody witness this encounter? *
    -- Select One --YesNo
21. If there was a witness, what is their name and phone number?
23. Please provide a description of the encounter and your complaint. *
27. I hereby affirm that the facts described in this complaint are true and correct to the best of my knowledge, and I understand that the effected employee(s) could bring civil action against me if my allegations are malicious.*
    -- Select One --Yes
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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