INTERNAL USE ONLY
FORMAL
COMPLAINT INFORMAL COMPLAINT
________-_____ ________-_____
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FORNEY POLICE DEPARTMENT
PERSONNEL COMPLAINT FORM
STATE OF TEXAS
COUNTY OF KAUFMAN
BEFORE ME, the undersigned authority, on this date personally appeared the person whose
name is set out below as affiant who, after being first duly sworn upon oath deposed and said:
AFFIDAVIT
My name is ___________ __________ ____________, my date of birth is ____/____/________,
(First) (Middle) (Last) (mm/dd/yyyy)
and my address is ___________________, ____________, ___, ______ and _______________.
(Street) (City) (State) (Zip) (Country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in Kaufman County, State of Texas, on the _____ day of _______________, _______.
My telephone number is (____)____-_____. I am employed at __________________, located at
_______________________________, and my business telephone number is (____)____-_____.
My email is ____________________@__________ . ______.
I am hereby initiating this complaint against department member(s)_______________________,
ID number _________.
I make this affidavit voluntarily and from my own personal knowledge for the purpose of
complying with the requirement of Section 614.022 of the Texas Government Code which states
to be considered by the head of a local law enforcement agency, a complaint against a police
officer must be in writing and signed by the person making the complaint.
I have read Section 37.02 of the Texas Penal Code as set out on the following page, and I
am aware of the penalty set out therein for perjury.
