COUNTY OF LAKE
LAKE COUNTY GRAND JURY
P.O. BOX 1078
KELSEYVILLE, CALIFORNIA 95451
COMPLAINT FORM
ALL COMMUNICATIONS TO THE GRAND JURY ARE
CONFIDENTIAL
This complaint should be submitted after all attempts to resolve a situation have been explored unsuccessfully.
Person or agency your complaint is about
Name and Title :
Organization :
Address:
Telephone:
My complaint is: (be as precise as possible, providing dates, times, and names of individuals involved.
Describe more specific instances instead of making broad statements. Attach any available
photographs, correspondence or documentation which pertains to this complaint.)
Other persons or agencies you have contacted about this complaint.
Describe the action you wish the Grand Jury to take.
Using additional sheets, provide any further information you feel may be helpful in an investigation.
COMPLAINANT:
Name (please print)
Address City Zip Code
Signature
Telephone
State
Date
Your confidentiality will be vigorously protected. All complaints will be acknowledged promptly.
Please read additional instructions attached.
e-mail:
click to sign
signature
click to edit
COUNTY OF LAKE
LAKE COUNTY GRAND JURY
FURTHER INFORMATION REGARDING CITIZENS COMPLAINTS
Anyone may ask the Grand Jury to investigate a complaint. The Grand Jury will review all complaints received
from the public and, when appropriate investigate those complaints which contain allegation of wrong doing or
misconduct. While the Grand Jury will accept and review each complaint this is no assurance that the matter will be
officially investigated or any formal action taken. The following procedures govern the submission and processing
of such complaints.
A formal complaint should be prepared after all attempts to correct a situation have been explored unsuccessfully.
All complaints should be submitted in writing, dated and signed by the complainant. Anonymous complaints are
usually given less weight by the Grand Jury in deciding what to investigate.
Complaints may be submitted by letter, but this complaint form is preferred. Upon request, members of the Grand
Jury will assist citizens with the preparation of the complaint form.
Content of a complaint
Whether or not the standard complaint form is used, the following information should be included if at all possible:
Name, address and telephone number of the individual or organization the complaint is against.
If the complaint is against an individual in an organization, include the individual’s title or position in the
organization.
Describe the problem as clearly as possible.
Be as concise as possible, including dates, times, and names of individuals involved.
Cite specific examples as opposed to broad general accusations.
Attach any available evidence such as correspondence, documentation, photographs, etc..
Include the name, address and telephone number of the person preparing the complaint. Please state all efforts
or action taken to resolve the complaint up to this time. All materials, photos, statements, documents or other
evidence will be retained for confidentiality by the Grand Jury.
Confidentiality
The Grand Jury is forbidden by law to release any information about a complainant or about any investigation that
may be in progress. The confidentiality of the person making the complaint is rigorously protected.
The Grand Jury will study each complaint submitted. Each complaint will be acknowledged by letter as soon as
possible after it is received. After studying the complaint, the Grand Jury will determine if further investigation
should be undertaken. In any event, the complainant will be advised of the Grand Jury’s decision.
The Grand Jury may call on the complainant for further information or clarification of the complaint.