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2. Citizens/Police Complaint Form
   The City of Ypsilanti respects your privacy and will not distribute your personal information except as necessary to resolve your request or complaint. However, you should be aware that this information is subject to the State of Michigan’s public disclosure laws and may be disclosed upon request. You are encouraged to provide as much information as possible. It is helpful to the investigators to be able to follow up on information or speak to people involved in the incident to gather evidence. However, if you would like to submit a complaint anonymously, you may omit your identifying information on this form. Please submit this complaint to any of the following: Ypsilanti City Clerk or Manager, Ypsilanti Police Department, Ypsilanti City Attorney, Ypsilanti City Hall Drop Box, or online. Once submitted, this form will be sent to the Ypsilanti City Manager, the Ypsilanti Police Department Chief, and the Ypsilanti City Attorney to be investigated. Within seven days you will receive confirmation of receipt, accompanied with a copy of the complaint, unless submitted anonymously. This complaint will be investigated and findings of the investigation completed within 30 days unless notice is given that more time is needed for the investigation. For any further information please contact the City Clerk’s Office (734) 483-1100
4. Location of Incident*
6. Incident Date/Time *
   Incident Date/Time

   Incident Date/Time
8. Name of YPD Officer
10. Name of Witnesses or Others Involved
12. Witnesses Phone Number
14. Ypsilanti Police Department Report/Incident Number if known or applicable
16. Statement/Description of Incident*
    Include if there are any photographs or video relevant to this incident available and if any injuries were sustained.
18. PERMISSIONS
20. Are you willing to be contacted by the City for more information?*

    1. Yes
    2. No

    Check Appropriate Box
21. Do you want your name and contact information disclosed to the YPD?*

    1. Yes
    2. No

    If "no" please submit this form to the City Manager, who will remove your identifying information before forwarding the incident description, above, to the YPD.
23. Would you consider mediation for this complaint?

    1. Yes
    2. No
25. IT IS VOLUNTARY, BUT HELPFUL TO KNOW THE FOLLOWING INFORMATION ABOUT YOU:
27. Gender

    1. Male
    2. Female
    3. Other
    4. Decline to State
28. Racial/Ethnic Background:

    1. Asian
    2. Pacific Islander
    3. Hispanic/Latino
    4. Native American
    5. African American
    6. Caucasion
    7. Other
    8. Decline to State
32. YOUR INFORMATION: DO NOT COMPLETE THE INFORMATION BELOW IF YOU WISH TO REMAIN ANONYMOUS
34. First Name
35. Last Name
37. Address
39. City
40. State
41. Zip Code
43. Phone Number
44. Fax Number
46. Email Address
48. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your document will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
50. Electronic Signature
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field