LCU Police Department Complaint Processing Form

LCU Police Department Complaint Processing Form
Name

PrefixFirst NameMiddle NameLast NameSuffix
Contant Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Day & Date of Incident(s)
Approximate Time of Incident(s)
Location of Incident
Report Number(s) of Incident
Involved Employees
Witnesses
Statement
Clearly and chronologically state what happened, ensuring that you articulate the conduct, facts, and evidence in support of your allegation(s). Please sign all pages that bear your statement and initial all corrections. Please include any available witness information, including addresses and phone numbers.

Filing a false complaint against a police employee is a violation of the Texas Penal Code, Section 37.02. If a person knowingly and intentionally makes a false statement under oath, or swears to the truth of a false statement previously made under oath, a person may be found guilty and punished by a fine of up to $4,000, confinement in jail up to one year, or by both fine and imprisonment.

I have read each page of this statement consisting of ______page(s). Corrections if any, bear my initials. I certify the facts contained herein are true and correct.
Statment
Should be Empty:

Statement