509 S. Alton Blvd. Alton TX, 78573 Office (956) 432-0700 Fax (956) 432-0711
To file a complaint, please complete all the items on this form describing briefly the incident that involved you
and any member of the Alton Police Department. This form must be notarized; notary service is available at
the Alton Police Department or Alton City Hall. A supervisor will review the completed form and speak with
you. You may also mail the form to the address listed above to the attention of the Office of Professional
Standards or scan and email the notarized form to altonpd@alton-tx.gov . Any complaints regarding the Chief
of Police can be forwarded in the same manner to the attention of City Manager Jeff Underwood
jeff.underwood@alton-tx.gov
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Your Name: ______________________________ Today’s Date: _________________
Address:____________________________________________
City: _____________ State:____________ Zip: ______________
Home Phone: ______________Work Phone: __________________ Cell Phone:__________________
DOB: _______________ Sex: Male ____ Female____
Race: American Indian____ Hispanic____ Asian/Filipino____
Anglo ___ African American ____ Other ____
Date of Incident: __________ Time: ____________ (A.M. or P.M.)
Location of where incident occurred:
_________________________________________________________________
Name of Officer (s) involved: _________________________ Badge Number of Officer _______
_________________________ Badge Number of Officer _______
Officer’s Race, Ethnicity: ______________________
(1) Name of Witness: ___________________________
Address: _____________________________________
Home Phone: _____________ Work Phone: ____________ Cell Phone: ________________
Fill out Affidavit on Following Form
