Commendation Form

Citizen Information

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Name

Address

Primary Contact Number

Email address

Incident Details

Incident Date

Year

Month

Day

Approximate Time

Hour

Minute

Incident Location

Enter the address or nearest intersection where the incident took place

Officer(s) Involved

Enter the name(s) and/or badge number(s) or description(s) of officer(s) involved.

Description of Incident

THECITY
OFBURLINGTON

City Hall
149 Church Street
Burlington, VT 05401
Hours: M-F 8am-4:30pm

(802) 865-7000

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