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Complaint Form

To report a crime involving a person, business or location in Westchester County directly to the District Attorney’s Office, complete and submit the complaint form or call (914) 995-TIPS (914-995-8477).

Formulario De Quejas
Fòm Pou Depoze Yon Plent
投诉表
고소고발장 양식

To submit a complaint, please complete and return this form. Clearly and legibly type or hand write your complaint. Enclose COPIES of any supporting materials, including any documents or photographs relevant to your complaint. DO NOT INCLUDE ORIGINAL DOCUMENTS. The COPIES you provide will not be returned.

Items and information submitted with your complaint may be disclosed in court proceedings or to other agencies. 

This form and all supporting materials must be submitted to this Office by hand-delivery, postal mail, or electronic mail sent to complaintresponse@westchesterda.net.

Notice: Pursuant to the Penal Law, Section 210.45, it is a crime punishable as a class misdemeanor to knowingly make a false statement herein.

 

Your Information

Enter your first name.
Enter your last name.
Enter your date of birth.
Enter your street address.
Enter your municipality.
Enter your Zip code.
A ten-digit phone number is required
A ten-digit phone number is required
An E-mail is required

 

Subject Information: (Person(s) or business(es) whom you are making a complaint about)

Enter subject's name.
Enter subject's date of birth.
Enter subject's address.
Enter subject's municipality.
Enter subject's Zip Code.
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Enter subject's name.
Enter subject's date of birth.
Enter subject's address.
Enter subject's municipality.
Enter subject's Zip Code.
Enter 10-digit number,
Enter 10-digit number,
Enter subject's E-mail

 

Law Enforcement Agency Information

Have you reported this complaint to any other law enforcement agencies?
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Please state your complaint clearly and concisely. Provide a factual summary of events. Be specific. Where appropriate include relevant dates, times and locations as well as the name, address and phone number of any person known to have information or evidence related to your complaint. If necessary, please use additional paper to complete your complaint - sign and date each page.

Notice: Pursuant to the Penal Law, Section 210.45, it is a crime punishable as a Class “A” Misdemeanor to knowingly make a false statement in this complaint or in any document submitted with this complaint.

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