Personnel Complaint Form

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LT-107 (Rev. 1/07)
NORTH CAROLINA DIVISION OF MOTOR VEHICLES
LICENSE AND THEFT BUREAU
PERSONNEL COMPLAINT FORM
Date Received:
Type of Complaint Filed:
Personnel
Time Received:
Policy
Other:
Date Closed:
1.
COMPLAINANT IDENTIFICATION
Name:
Home
Address:
Business
Address:
Telephone
Telephone
Home:
Business:
Other
Information:
2.
ACCUSED IDENTIFICATION
Rank / Name:
District:
Rank / Name:
District:
Rank / Name:
District:
3.
COMPLAINT RECEIVED BY:
Rank / Name:
District:
Date:
Date:
Communication Media:
4. NAMES, ADDRESSES AND TELEPHONE NUMBERS OF WITNESS OR OTHER COMPLAINANTS
(Details on next page)

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