November 2017
LEANDER POLICE DEPARTMENT
Personnel Complaint
705 Leander Dr
Leander, Texas 78641
(512) 528-2800
Complainant’s full name: Phone number:
Complainant’s address:
Incident Information
Location of incident: Date:
Was an arrest made? Yes No If yes, complete this section
Name of person arrested: Phone number:
Address of person arrested:
Complainant’s relationship to person arrested:
Name or other identifying information about the LPD employee against who the allegation is
being made:
Witness Information if any
Witness name: Phone number:
Witness’s address:
Include additional witness information on the reverse side of form
Nature of Complaint:
Continue on reverse side if more space needed
Complainant’s Signature: Date:
Department use only
Date received: Received by:
