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***CONFIDENTIAL*** ROLLINGWOOD POLICE DEPARTMENT (City of Rollingwood)

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***CONFIDENTIAL***
ROLLINGWOOD POLICE DEPARTMENT
CITIZEN COMPLAINT FORM
Chief Jason Brady - Confidential
Rollingwood Police Department
403 Nixon Drive
Rollingwood, TX 78746
All complaints concerning Rollingwood Police Department personnel are taken seriously and will be
investigated thoroughly and impartially. Persons wishing to make a formal complaint against a
department employee must submit this completed form. The form must be written legibly or typed. When
completed, the form may be taken directly to the Rollingwood Police Department, emailed to
professionalstandards@rollingwoodtx.gov, or mailed to the address above. An investigator will review
the completed form and speak with you, after which time this form must be sworn to and notarized.
The mere filing of this complaint does not substantiate the allegations. If an investigation determines the
employee acted improperly, disciplinary action will be taken. You will be notified of the results when the
investigation is complete.
TEXAS GOVERNMENT CODE
Complaints Against Law Enforcement Officer or Firefighter
Sec. 614.022 Complaint to be in Writing and Signed by Complainant. To be considered by the head
of a state agency or by the head of a fire department or local law enforcement agency, the complaint must
be: (1) in writing; and (2) signed by the person making the complaint.
Sec. 614.023 Copy of Complaint to be Given to Officer or Employee. (a) A copy of a signed complaint
against a law enforcement officer of this state or a fire fighter, detention officer, county jailer, or peace
officer appointed or employed by a political subdivision of this state shall be given to the officer or
employee within a reasonable time after the complaint is filed. (b) Disciplinary action may not be taken
against the officer or employee unless a copy of the signed complaint is given to the officer or employee.
TEXAS PENAL CODE
Perjury and Other Falsifications
Sec. 37.08 False Report to Peace Officer or Law Enforcement Employee – Class B Misdemeanor
(a) A person commits an offense if, with the intent to deceive, he knowingly makes a false statement that
is material to a criminal investigation and makes the statement to: (1) A Peace Officer conducting the
investigation; or (2) any employee of a law enforcement agency that is authorized by the agency to
conduct the investigation and that the actor knows is conducting the investigation.
I affirm that I have read and understand the above information. I hereby wish to file an official complaint
and swear the information on the following pages is true and correct to the best of my knowledge.
Signature of Complainant
Printed Name of Complainant
Date and Time
Page 1 of 4
ROLLINGWOOD POLICE
DEPARTMENT
CITIZEN COMPLAINT FORM
Page 2 of 4
Your Name: Today's Date:
Date of Birth:
Male
Female
Your Address:
City: State: Zip:
Email address:_________________ Work Phone: Cell Phone:
Please provide as much information as you can about the incident.
Date of Incident:
Time:
AM PM
Location:
If you do not know the officer's name and/or badge #,
please give a physical description in the space below, including race and sex.
Officer(s) Involved: Badge #:
Officer(s) Involved: Badge #:
Officer(s) Involved: Badge #:
Officer(s) Involved: Badge #:
Officer(s) Involved: Badge #:
If another witness of any kind was present, please list them here as described above.
Witness:
Address:
Phone Number(s):
Witness:
Address:
Phone Number(s):
Witness:
Address:
Phone Number(s):
Do you have criminal and/or traffic charges pending from this incident?
If yes, please list:
Do you have any evidence which you wish to present with this complaint?
If yes, please list:
What type of complaint are you filing?
Service Complaint (Dissatisfaction with police service) Inappropriate Conduct
Excessive Force
Rudeness
Alleged Criminal Conduct Other
Signature:
Page 3 of 4
ROLLINGWOOD POLICE
DEPARTMENT
CITIZEN COMPLAINT FORM
Your Name:
Today's Date:
Description of Incident:
Signature of Complainant
Date Time
Sworn to and subscribed before me, this day of , .
Notary Public, State of Texas
ROLLINGWOOD POLICE
DEPARTMENT
CITIZEN COMPLAINT FORM
Your Name:
Today's Date:
Signature of Complainant
Date
Sworn to and subscribed before me, this day of , .
Time
Notary Public, State of Texas
Page 4 of 4
Description of Incident (continued):
RWPD Form 02
Revised 05/2020
Submit Form HERE
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***CONFIDENTIAL*** ROLLINGWOOD POLICE DEPARTMENT (City of Rollingwood)

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Completed 16 July 2020

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