Misd Police Department Citizen Complaint Form (Page 2 of 2) in pdf

Misd Police Department Citizen Complaint Form Page 2

NARRATIVE (CONT’D)

“37.02 Perjury.--A person commits an offense if, with the intent to deceive and with knowledge of the statement's meaning: makes a false

statement under oath or swears to the truth of a false statement previously made and the statement is required or authorized by law to be made

under oath; or makes a false unsworn declaration under Chapter 132, Civil Practice and Remedies Code.”

___, do hereby swear or affirm, under penalty of perjury, that the allegations made by me in this Complaint Form are,

(Print Name)

to the best of my knowledge and belief, true and correct.

__________________________________

Signature of Complainant

(Parent or Guardian if Minor)

STATE OF TEXAS

COUNTY OF TARRANT

Sworn to and subscribed before me this

_________ day of

, 20 , by

_____.

Personally Known to Me

Produced Identification

________________________________

Notary Public in and for Tarrant County, Texas

________________________________________

My Commission Expires: __________________

Law Enforcement Officer (Signature and Badge/Id #)

[NOTARY SEAL ABOVE]

AUTHORIZATION FOR ADMINSTRATIVE INVESTIGATION

(Office of Internal Affairs Use Only)

Authorizing Member:

Date Received:

(Chief of Police or Designee)

Assign to Office of Internal Affairs

Assign to Supervisor

Other/See Attached Information

IA Tracking Number:

IA Receiving Member:

Date Received:

Assigned to:

Date Assigned:

(04/2015)

Misd Police Department Citizen Complaint Form Page 2