Rutgers
Police Department – Newark, New Jersey
Internal Affairs Report Form
Internal
Affairs Case No. _________
Name
Alias
Address
City
State Zip Phone
DOB
SSN Age Sex Race
Employer/School
Phone
Nature
of Complaint
Complaint
Against (Name/s)
Date
Time Date/Time Reported How
Reported
Incident
Location Dist/Area Beat
Description
of Incident
Description
of Any Injuries
Place
of Treatment Doctor’s Name
Date
of Treatment
Signature
of Complainant Date
Report
Received By Badge No. Date Received
Forwarded
to: Internal Affairs Other
Unfounded
Due to Insufficient Information
Comments
Signature
of Complainant Badge No. Date
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