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Citizen Complaint Form

  1. Kinston Department of Fire and Rescue Seal

  2. P. O. Drawer 339, 401 E Vernon Avenue Kinston, North Carolina 28502 Office Phone: 252-939-3164 Fax Phone : 252-939-3157

  3. Race:*

  4. Complaint Against:*

  5. Is the Offense Criminal in nature or Civil in nature?*

  6. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  7. All of the above information is correct, accurate, true to the best of my knowledge, and electronically signed by me at this date and time.

  8. Leave This Blank:

  9. This field is not part of the form submission.