SANTA ANA POLICE DEPARTMENT
ADMINISTRATIVE COMPLAINT FORM
FOR OFFICE USE ONLY
DATE REPORTED:________TIME REPORTED:_______ RECEIVED BY:__________
DATE OF INCIDENT:_____________________ TIME OF INCIDENT:____________
LOCATION OF INCIDENT:_____________________________________________
WARNINGS AND INFORMATION
State of New Mexico Statute 30-39-1:
1) It is unlawful for any person to intentionally make a report to a law enforcement
agency or official, which report he knows to be false at the time of making it, alleging a
violation by another person of the provisions of the Criminal Code (30-1-1 NMSA 1978).
2) Any person violating the provisions of this section is guilty of a misdemeanor.
I UNDERSTAND THAT KNOWINGLY MAKING A MATERIALLY FALSE OR UNTRUE
STATEMENT DURING THE COURSE OF THIS COMPLAINT PROCEDURE MAY
SUBJECT ME TO CRIMINAL OR CIVIL LAW LIABILITY.
I realize that it may become necessary during the investigation of this complaint, for me
to meet with a member(s) of the Police Department to discuss this complaint, either in
the presence or absence of the accused member(s), at the discretion of the department.
I hereby accept and agree that if any action is initiated through a court or administrative
hearing as a result of my complaint, my testimony before these hearings may be
required. I hereby agree to make myself available to the aforementioned court or
administrative hearing when requested to do so.
I HAVE READ THE ABOVE WARNINGS AND INFORMATION, OR HAVE HAD IT
READ TO ME. I UNDERSTAND IT AND DO HEREBY MAKE THE ATTACHED
PERSONAL STATEMENT VOLUNTARILY AND OF MY OWN FREE WILL.
Signature of Complainant Witness Signature
Page _____ of _____
click to sign
click to edit