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2. Name of employee (if known)
3. Date of contact with employee
5. Location of contact (i.e. address, cross streets, business name, etc.)
7. What initiated your contact with the employee? (Check one)

   1. Police response to your call
   2. Traffic stop
   3. Made a report at the police station

   1. Pick up property
   2. Visit a detective

   1. Visit/release a prisoner
   2. Other
9. What would you like to commend about the employee's performance?
11. I give permission for the City of Carbondale to publicly display my above submission on the City's website. I understand that my personal information such as name and address will NOT be published, only the story submitted.*

    1. Yes
    2. No
13. OPTIONAL:
15. Name
16. Email Address
18. Address
20. City
21. State
22. Zip Code
24. Phone Number
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field