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Service Complaint Form

  1. Because of the nature of law enforcement, we understand that citizens on occasion may object to the actions of the police, or may feel their conduct is inappropriate. Therefore, we have established procedures for citizens to report their concerns to the Department. Part of this procedure includes accepting and reviewing this form.

  2. Complainants Information

  3. Complaint Information

  4. Witness Contact Information

  5. Please be aware that information submitted through the Town of Purcellville Government website is considered a Public Record under the Virginia Public Records Act, and may be subject to release by the Town in response to a request made under the Virginia Freedom of Information Act.

  6. Do not submit any unsolicited personally identifiable information including (but not limited to) your: (1) social security number; (2) driver's license number; (3) bank account numbers; (4) credit or debit card numbers; (5) personal identification numbers (PIN); (6) electronic identification codes; (7) automated or electronic signatures; or (8) passwords; or (9) any other numbers or information that can be used to access your assets, obtain identification, act as identification, or obtain goods or services.

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  8. This field is not part of the form submission.