Form DBO-ENF53 "Citizen Complaint Against Peace Officer Form" - California

What Is Form DBO-ENF53?

This is a legal form that was released by the California Department of Business Oversight - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2020;
  • The latest edition provided by the California Department of Business Oversight;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DBO-ENF53 by clicking the link below or browse more documents and templates provided by the California Department of Business Oversight.

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Download Form DBO-ENF53 "Citizen Complaint Against Peace Officer Form" - California

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Provide specific information about the alleged misconduct. If more space is needed,
attach additional pages. . Do Not Send Original Documents.
Total # Pages
Attached:
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
DBO–ENF 53 (Rev. 08-20)
Citizen Complaint Against Peace Officer Form
CITIZEN COMPLAINT AGAINST PEACE OFFICERS
Please Read the Information Collection, Use and Access notice on page 2
(916) 322-6067/ (866) 275-2677 Toll Free – CA Only
Mail form to:
TTY/TDD (800) 735-2922 (California Relay Service)
Deputy Commissioner of Enforcement Division
2101 Arena Blvd
For TTY/TDD Outside California contact your state’s relay
service number at
http://www.fcc.gov/dro/trsphonebk.html
Sacramento, CA 95834
DBO Web Site:
http://www.dbo.ca.gov
Email form to:
DBOPeaceOfficerComplaint@dbo.ca.gov
SECTION 1 - YOUR CONTACT INFORMATION (To receive a response in writing, you must provide your mailing address)
First Name:
MI:
Last Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Email:
SECTION 2 – WITNESSES AND VICTIM (if different from reporting party)
First Name:
MI:
Last Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Email:
SECTION 3 – PEACE OFFICER INFORMATION
Employee's Name:
Employee’s Office Location if known:
City:
State:
Zip Code:
Employee's Phone:
SECTION 4 - YOUR STATEMENT OF COMPLAINT
Provide specific information about the alleged misconduct. If more space is needed, attach additional pages.
Total # of Pages
Attached:
Do Not Send Original Documents.
SECTION 5 – RACIAL OR IDENTITY PROFILING
Is your complaint based on the belief that you were targeted based on race, color, ethnicity, national origin, gender, age,
religion, gender identity or expression, sexual orientation, or mental or physical disability: Yes
No
If Yes, please check all that apply:
Race ☐ Color ☐ Ethnicity ☐ National Origin ☐ Gender ☐ Age ☐ Religion ☐ Gender Identity or Expression ☐
Sexual Orientation ☐ Mental Disability ☐ Physical Disability ☐ Other (please explain) ☐
[If you need more space and are using this fillable form, create a document (e.g. MS Word or WordPerfect) to print and attach.]
Signature:
Date:
Provide specific information about the alleged misconduct. If more space is needed,
attach additional pages. . Do Not Send Original Documents.
Total # Pages
Attached:
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
DBO–ENF 53 (Rev. 08-20)
Citizen Complaint Against Peace Officer Form
CITIZEN COMPLAINT AGAINST PEACE OFFICERS
Please Read the Information Collection, Use and Access notice on page 2
(916) 322-6067/ (866) 275-2677 Toll Free – CA Only
Mail form to:
TTY/TDD (800) 735-2922 (California Relay Service)
Deputy Commissioner of Enforcement Division
2101 Arena Blvd
For TTY/TDD Outside California contact your state’s relay
service number at
http://www.fcc.gov/dro/trsphonebk.html
Sacramento, CA 95834
DBO Web Site:
http://www.dbo.ca.gov
Email form to:
DBOPeaceOfficerComplaint@dbo.ca.gov
SECTION 1 - YOUR CONTACT INFORMATION (To receive a response in writing, you must provide your mailing address)
First Name:
MI:
Last Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Email:
SECTION 2 – WITNESSES AND VICTIM (if different from reporting party)
First Name:
MI:
Last Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Email:
SECTION 3 – PEACE OFFICER INFORMATION
Employee's Name:
Employee’s Office Location if known:
City:
State:
Zip Code:
Employee's Phone:
SECTION 4 - YOUR STATEMENT OF COMPLAINT
Provide specific information about the alleged misconduct. If more space is needed, attach additional pages.
Total # of Pages
Attached:
Do Not Send Original Documents.
SECTION 5 – RACIAL OR IDENTITY PROFILING
Is your complaint based on the belief that you were targeted based on race, color, ethnicity, national origin, gender, age,
religion, gender identity or expression, sexual orientation, or mental or physical disability: Yes
No
If Yes, please check all that apply:
Race ☐ Color ☐ Ethnicity ☐ National Origin ☐ Gender ☐ Age ☐ Religion ☐ Gender Identity or Expression ☐
Sexual Orientation ☐ Mental Disability ☐ Physical Disability ☐ Other (please explain) ☐
[If you need more space and are using this fillable form, create a document (e.g. MS Word or WordPerfect) to print and attach.]
Signature:
Date:
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
DBO–ENF 53 (Rev. 08-20) Page 2 of 3
Citizen Complaint Against Peace Officer Form
CITIZEN COMPLAINT AGAINST PEACE OFFICER FORM
Information Collection, Use and Access
Notice Required Under State Law
The following notice is required by state law under the Information Practices Act of 1977 (California Civil
Code Section 1798.17).
All information you provide regarding the performance of this Department is voluntary and optional.
However, if you choose not to include all or any part of the information requested, the Department may be
unable to fully investigate or respond to your comment or complaint.
All investigations are conducted objectively, with a goal of maintaining public confidence and departmental
integrity. After completion of the investigation, complaints are directed through the chain of command for an
impartial review. After final approval, the citizen is provided with a closing written response. Complaints
may not always be resolved to a citizen’s satisfaction.
We may share your personal information, as needed, with licensed business entities or individuals to
facilitate resolution of your comment or complaint. We may also share your information with other
government agencies or self-regulatory organizations.
The Commissioner is responsible for the performance of all duties, the exercise of all powers and
jurisdiction, and the assumption and discharge of all responsibilities vested by law in the Department. The
Commissioner has and may exercise all the powers necessary or convenient for the administration and
enforcements of, among other laws, the laws described in Financial Code Section 300. The Commissioner
may issue such rules and regulations consistent with law as he or she may deem necessary or advisable in
executing the powers, duties, and responsibilities of the Department.
You have a right to see your personal information. The official responsible for maintaining information
gathered by the Department of Business Oversight is:
DBO Privacy Officer
Department of Business Oversight
2101 Arena Blvd
Sacramento, CA 95834
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
DBO–ENF 53 (Rev. 08-20) Page 3 of 3
Citizen Complaint Against Peace Officer Form
DBO’s Privacy Notice on Collection
DBO Collects and Uses Personal Information: The DBO collects the information requested on this form
as authorized by Penal Code sections 832.5 and 13012. The DBO uses this information to conduct an
investigation of your Citizen’s Complaint. Use of the personal Information DBO collects is subject to
limitations contained in the Information Practices Act of 1977 and other applicable state and federal laws.
Providing Personal Information Is Mandatory: When providing information or documents, please do not
include unrequested personal information such as a Social Security number, driver’s license number, or
financial information.
DBO May Disclose Your Personal Information: We may share your personal information with State and
Federal Regulators, and law enforcement agencies. Your personal information may also be disclosed:
In response to a Public Records Act request, as allowed by the Information Practices Act.
To another governmental agency as required by state or federal law.
In response to a court order or administrative order, a subpoena or a search warrant.
Your Access to Your Personal Information: You may review the records maintained by DBO that
contain your personal information. To request access, contact: DBO Privacy Officer, 2101 Arena
Blvd, Sacramento, CA 95834.
Contact Information: For questions about a written complaint that you submitted to the DBO,
please specify the specific record that you are seeking. You may mail your request to Deputy
Commissioner of Enforcement, 2101 Arena Blvd, Sacramento, CA 95834 or email your
request to DBOPeaceOfficerComplaint@dbo.ca.gov.
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