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IMPORTANT!
7/5/2008
Download our City Water Restrictions

Complaintant Information:

Name of Complaintant	*
Date of Birth (mm/dd/yyyy):	*
Home Address:	*
Home Phone: (numbers only)	*
Name of Employer:
Business Phone: (numbers only)

Incident Information

Date of Incident (mm/dd/yyyy):

Time of Incident:

Location of Incident:

If this complaint is made on behalf of a minor child, provide the following information:

Name of Minor Child:

Date of Birth
(mmddyyyy):

Complaintant's Relationship to Minor Child:

Name of Employee Involved:

Description
(if name not known):

Race:
Sex:	Male Female
Age:
Height:
Weight:
Vehicle #:
Dress:

Witness(es)

Name	Address	Business Ph:	Residential Ph:

Details of Complaint - Limit 2000 characters

IMPORTANT - PLEASE READ CAREFULLY BEFORE SUBMITTING
Do you affirm that the information you have provided is accurate and true? YES

The information you submit will be recorded as a Mebane Police Department police report. Persons filing false reports will be prosecuted. Information related to your electronic report, including but not limited to your computer's IP address, may be used as evidence in prosecution of individuals who file a false report as defined by the statute below.

North Carolina General Statute 14-225 False reports to law enforcement agencies or officers
Any person who shall willfully make or cause to be made to a law enforcement agency or officer any false, misleading or unfounded report, for the purpose of interfering with the operation of a law enforcement agency, or to hinder or obstruct any law enforcement officer in the performance of his duty, shall be guilty of a Class 2 misdemeanor.