Fill - Free fillable Citizen Complaint Form Citizen Complaint Form2013 (University of West Florida) PDF form

Citizen Complaint Form

Complainant (your full name):

Street Address:

City/State/Zip:

Phone(s):

I would like to file a complaint against a member of the University of West Florida Police Department,

known to me as (insert name or description of member):

The basis of my complaint is as follows:

The following are the names and addresses of all other persons known to me to have been witness to the

incident:

Name:

Street Address:

City/State/Zip:

Phone(s):

Name:

Street Address:

City/State/Zip:

Phone(s):

Name:

Street Address:

City/State/Zip:

Phone(s):

I do hereby certify that the foregoing statement is true and complete to the best of my knowledge. I

understand that any deliberate falsification or misrepresentation of information may subject me to possible

civil and/or criminal penalties.

Dated this _____________ day of ___________________________________, ________________

Complainant Signature: ________________________________________________

Sworn to and subscribed

this _____________ day of ___________________________________, ________________

Notary: ____________________________________________________________

Please deliver or mail to:

UWF Police Department

11000 University Parkway, Bldg. 94

Pensacola, FL 32514

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Citizen Complaint Form Citizen Complaint Form2013 (University of West Florida)

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Fill Online, Printable, Fillable, Blank Citizen Complaint Form Citizen Complaint Form2013 (University of West Florida) Form