Citizen Complaint Form - Paxton Police Department printable pdf download

PAXTON POLICE DEPARTMENT

CITIZEN COMPLAINT FORM

Name of Complainant:___________________________________

Date Received: ______________________________

Address:______________________________________________

Time Received: ______________________________

_____________________________________________________

By: ________________________________________

Phone#:______________________________________________

Date(s) of Incident: __________________________________________________________________________________

Officer(s) Involved: __________________________________________________________________________________

__________________________________________________________________________________

Complaint Narrative:_________________________________________________________________________________

__________________________________________________________________________________________________

Witnesses and Contact Information: ____________________________________________________________________

__________________________________________________________________________________________________

I hereby certify that the above statement is true to the best of my knowledge.

Signed under the pains and penalties of perjury.

Signature: _________________________________________________ Date: ___________________________________

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Conclusion: ________________________________________________________________________________________

__________________________________________________________________________________________________

Chief of Police Signature: ________________________________________ Date: ________________________________

Citizen Complaint Form - Paxton Police Department