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2. Date Submitted
   Date Submitted
4. Feedback Type

   1. Compliment
   2. Comment or Suggestion
   3. General Complaint
   4. Complaint regarding conduct of BIPD or officer(s)
6. Anonymous

   1. I wish to remain anonymous
8. First Name
9. Last Name
11. Address1
13. Your email address (optional):
14. Your contact phone number (optional):
16. City
17. State
18. Zip
20. Provide detail about the event or incident that prompted you to complete this form:
22. For security purposes please type in the current date using only numbers:
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24. 1. Receive an email copy of this form.
25. Email address

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