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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