Complaint or Compliment form — Village of Rhinebeck

Village of Rhinebeck Police Department

Public Compliment or Complaint Form
With Formal Complaint Option

The Village of Rhinebeck Police are dedicated to providing the highest quality police services to residents, business owners, and visitors. Your compliments, concerns, and complaints are important to us and we appreciate your taking the time to contact us.

Submitting the online form below sends it to Sgt Peter Dunn.
Alternatively, you may download a PDF versi on of the form or pick up a paper copy at Village Hall or at the Police Department. After it’s filled out, either email or mail it to us, or drop it off.

pdunn@rhinebeckpd.com
Rhinebeck Police Department, attn: Sgt Peter Dunn
76 E. Market St, Rhinebeck, NY 12572

Please indicate if this is a:

Complaint

Compliment

Name of person with the compliment/complaint

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please describe the incident and circumstances of your contact with the police.

Please provide any information you have about the police department employee(s) involved.

Name

First Name

Last Name

Badge Number

Vehicle Number

If you do not have the name or badge number, feel free to provide information that may help us identify the officer.

e.g., gender, race/ethnicity, approximate age, height, etc.

Please provide any information you have about witnesses to the incident.

Names, addresses, phone numbers, email addresses, etc.

If other individuals have relevant knowledge about the incident, provide the following.

Names, addresses, phone numbers, email addresses, etc.

Are you filling out this form for your own compliment or complaint, or are you filling it out on behalf of someone else?

For myself

On behalf of someone else

If you are completing this form on behalf of someone else, please provide your contact information. SKIP if you are filling out the form for your own compliment or complaint.

Your connection to the person filing the complaint or compliment:

Your name

First Name

Last Name

Agency/Affiliation if applicable:

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

The section below pertains to formal complaints.

Please skip if this is not a formal complaint and scroll down to click SEND.

If you want to make this a formal complaint against one or more officers, please review the following statement and add your electronic signature by typing your name below.

I realize that it may be necessary for me to meet with officials of the Village of Rhinebeck to discuss my complaint and facilitate any investigation. I understand that if my complaint results in a legal proceeding my testimony will be needed and I hereby agree to make myself available if required to do so. FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO NEW YORK STATE PENAL LAW SECTION 210.45.

Date

YYYY

Village of Rhinebeck Police Department

Public Compliment or Complaint FormWith Formal Complaint Option

Village of Rhinebeck

Public Compliment or Complaint Form
With Formal Complaint Option