Mineral Wells Police Department
212 S. Oak Avenue
Mineral Wells, Texas 76067
(940) 328-7770
PERSONNEL COMPLAINT FORM
Report of Inquiry / Incident
Briefly describe in your own words what occurred. If more space is needed, attach additional page(s).
Government Code: 614.022
023 Complaints Against Law Enforcement Officers
In order for a complaint, against a law enforcement officer in the State of Texas, to be considered by a chief or the head
of a police department, the complaint must be placed in writing and signed by the person making the complaint.
A copy of the signed complaint must be presented to the affected officer or employee within a reasonable amount of
time after the complaint is filed and before any disciplinary action may be taken against the affected employee.
Additionally, the officer or employee may not be terminated from employment based on the subject matter of the complaint
unless the complaint is investigated and evidence is substantiated to prove the allegation(s) of misconduct.
Penal Code: 37.02
03 Perjury and Aggravated Perjury
It is a criminal offense in the State of Texas for a person, with the intent to deceive and with knowledge of the statement’s
meaning, to make a false statement under oath or swear to the truth of a false statement previously made and where that
statement is required or authorized by law to be made under oath. This crime is punishable as a Class A misdemeanor.
This criminal offense may be enhanced as a 3
rd
degree Felony if the person commits perjury, as defined above, and the false
statement is made during or in connection with an official proceeding; and is material.
If allegation(s) are sustained and it is determined an officer/employee acted improperly, disciplinary action will be taken. Because
this is a serious matter, with serious consequences potentially resulting for the employee(s) involved, all formal complaints are
required to be signed, as sworn to, and notarized.
I hereby attest that the statement made is my own and the information provided is true and correct.
I understand that if my statement is found to be false or otherwise untrue, I may be subject to criminal charges.
______________________________________ _____________________________________
Signature of Complainant Date Witnessed by Date
Sworn to and Subscribed before me, the ___________________ day of ___________, 20 ___.
[ Notary SEAL ] Notary public in and for the State of Texas.
My Commission expires ____/____/_______. Signature of Notary: ____________________________
MWPD / IAIR Form 1 / Revised: July 2013 Page 2 of 2
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