Police-Citizen Complaint And Tracking Form printable pdf download

Police-Citizen Complaint And Tracking Form

ARKANSAS STATE POLICE

ASP-50

(Rev. 05/11)

Police-Citizen Complaint and Tracking Form

Control Number

Member’s Name

Complainant’s Name:

Home Address:

Home Phone:

Home Address:

Home Phone:

(2) Witness or Other Complainants:

Home Address:

Home Phone:

(

)

Date and Time of the Incident:

Location of the Incident:

Details of the Complaint

COMPLAINT AFFIRMATION

I, __ ___________________________________, do hereby affirm that the foregoing information is true and

complete to the best of my knowledge and belief. I understand that any false, misleading, or untrue statements or

writings given to any person(s) investigating this complaint may subject me to civil prosecution by the accused.

I further realize that it may become necessary, during the investigation of this complaint, for me to meet

with a member(s) of the Arkansas State Police to discuss this complaint, either in the presence or absence of the

accused department member(s) at the discretion of the department. I hereby accept the premise that if any action

is initiated through a court or administrative hearing as a result of my complaint, my testimony at these hearings

may be required.

I hereby agree to make myself available to any such court or administrative hearing when

requested to do so.

Signed:

(First/MI/Last Name)

Name of Accepting Department Member:

(Rank/First/MI/Last Name/Badge #)

Date:

Time:

(Mo/Day/Yr)

Police-Citizen Complaint And Tracking Form