Public Integrity Complaint Form, Dallas County
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1
2SERVICE CASE NUMBER:
____________________
DA NUMBER:
______________________
(For Office Use Only)
(For Office Use Only)
RETURN TO:
PUBLIC INTEGRITY DIVISION
SUSAN HAWK
Frank Crowley Courts Building
CRIMINAL DISTRICT ATTORNEY
133 North Riverfront Blvd., LB19
DALLAS COUNTY, TEXAS
Dallas, Texas 75207-4399
214.653.3714
COMPLAINT FORM
This complaint form is provided to you with the understanding that this office may conduct investigations to determine if a firm or person is in
violation of Penal Laws of the State of Texas. We strongly recommend that you consult with your own private attorney to determine your legal rights and civil
remedies in this matter.
(PLEASE TYPE OR PRINT)
I.
INFORMATON ABOUT THE PERSON OR PARTY YOU ARE COMPLAINING OF:
__________________________________________________________________________________________________________________________
Full Name
__________________________________________________________________________________________________________________________
Address (Street, City, State, Zip)
Telephone_______________________________________________________________________________________________________________________
___ RACE:
______ SEX:
___ __ HT:
____WT:
___ HAIR:
___ EYES
:
___________ DATE OF BIRTH:
OR) APPROXIMATE AGE:
________________________________________________________
II.
INFORMATION ABOUT YOU:
1.
_______________________________________________________________________________________________________________
Your Full Name (and Company Name if Applicable)
______________________________________________________
___________________________________________________
Address (Street, City, State, Zip)
Social Security Number
_______________________________________________________________________________________________________________
Telephone Numbers (Office & Home)
III.
WITNESS INFORMATION:
1.
WITNESS:
___________________________________________________________________________________________________
Name
__________________________________________________________________________________________________
Address and Telephone
2.
WITNESS:
____________________________________________________________________________________________________
Name
__________________________________________________________________________________________________
Address and Telephone
IV.
INFORMATION ABOUT OFFENSE:
1.
Date of offense:
______________________ Where did offense occur:
_______________________________________________
2.
What other agencies have you complained to:
________________________________________________________________________
3.
Have you complained to the person:
Their reply:
________________________________________________________________
__________________________________________________________________________________________________________________
4.
Please include copies of any related documents.
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