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Brazoria Police Department Citizen Complaint Form

Last Name
First Name
Address
City
State
Zip Code
Home Telephone
Cell Phone
Best time to contact you:
Document in your own words as much information as possible concerning your complaint and information. If a member of the Brazoria Police Department has assisted you in completing theis form or information., Please name the member in your documentation.
Statement
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application 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.
Electronic Signature

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