First Name *
Middle Name
Last Name *
Date of Birth *
Gender
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Male
Female
Nonbinary
Prefer not to respond
Sexual Orientation
Race
Street Address
City
State
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Phone Number
Secondary Phone Number
Best Time to Call
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6:00 A.M. - 10:00 A.M.
11:00 A.M. - 3:00 P.M.
3:00 P.M. - 8:00 P.M.
Anytime
Preferred Language
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English
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Other Language
Email Address
Booking Number
Incident Type (e.g. Traffic Stop, Pedestrian Stop, etc.)
Incident Date *
Arrested During Incident *
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Yes
No
N/A
Incident Location *
Crime Report Number
Describe any Injuries Suffered
First Name
Last Name
Phone Number
Email Address
KCSO Employee(s) (if known)
KCSO Employee(s) (if known)
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Add another KCSO Employee
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Description (If name unknown)
Winess(es)
Add up to 4 witnesses.
During this contact with Sheriff's Office personnel, do you believe you were stopped, arrested, searched, or detained by law enforcement based, at least in part, on your race or ethnicity (including color), nationality/national origin, gender, age, religion, gender expression, sexual orientation, mental disability, or physical disability?
No
Yes
