Livingston, NY · Columbia County
Procedure and Complaint Form for Complaints Against a Police Agency
This form lets a person file a complaint with the Columbia County Citizen's Review Panel about a police agency and provide details about the incident.
What this form is
Use this form to submit a complaint to the Columbia County Citizen's Review Panel for Police Reform about a police agency. It asks for complainant contact information, incident details, the subject of the complaint, and the type of complaint asserted. The instructions require a signed complainant affirmation and say to submit the original form in a sealed envelope marked confidential.
Who needs it
A person wishing to complain to the Citizen's Review Panel about a police agency should complete and submit this form.
How to submit it
Submit the original completed form in a sealed envelope marked confidential to the Columbia County Clerk of the Board, c/o Citizen's Review Panel, 401 State Street, Hudson, NY 12534.
About notarization
This document is signed without a notary; the complainant signs an affirmation under penalty of perjury and dates it.
How to submit this form
- 1
Download The Form
Download the police agency complaint form and its filing instructions.
- 2
Complete The Form
Enter your contact information and incident details, select the complaint type, and write a summary.
- 3
Add Details If Needed
If you need more space for your summary, continue on a separate sheet and attach it.
- 4
Sign And Submit
Sign and date the complainant affirmation, then mail the original in a sealed envelope marked confidential to the address in the instructions.
Frequently asked questions
- Do I need a notary for the police agency complaint form?
- No. The document does not require notarization; the complainant signs and dates an affirmation stating the information is true and complete under penalty of perjury.
- How do I submit the police agency complaint form?
- Send the original completed form in a sealed envelope marked confidential to the Columbia County Clerk of the Board, c/o Citizen's Review Panel, 401 State Street, Hudson, NY 12534.
- What information does the complaint form ask for?
- It asks for your name and contact information, incident date, time and location, the subject of the complaint if applicable, complaint type, and a summary.
Need something notarized?
This Procedure and Complaint Form for Complaints Against a Police Agency doesn’t need a notary — but if you have another Livingston form that does, a commissioned online notary can help.