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If you choose to complete the following complaint form, please include as much detail as possible, including the date, time, and location of the incident, the identities of the officer(s) involved if known, and a statement of the circumstances surrounding your complaint.

You should also include your name and a telephone number so an investigator may contact you if further information or clarification is needed. If you do not provide this information, and additional information is needed and we cannot contact you, then it may prevent the investigation from being further concluded.

You will be asked to provide a statement of your complaint with as much detail concerning the incident and why you believe the officers conduct is inappropriate.


Street Address

Are You a City of South Bend Resident? yes no

Zip/Postal Code

Home/Contact Phone #

Email Address 

Officer(s) Involved Name

Incident or Case Number (if applicable)

Date Incident Occured:

Describe the details of the incident in as much detail as possible:

PLEASE NOTE: It is a Misdemeanor crime in the State of Indiana to make a report of an allegation that you know is false. The South Bend Police Department takes these charges very seriously and if found that you are recording a false complaint you can be prosecuted, pursuant to IC 35-44-2-2 False reporting or informing

I have read the above statement and affirm that the officer misconduct I am reporting with this form is a true and accurate statement. I also understand that if the complaint is found to be false, I may be held criminally liable for prosecution under the above state statute.


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