FormXP 2007

The purpose of this form is to report possible policy violations or improprieties on the part of Acworth Police Department personnel. Departmental policy 2.04 (II.) states that personnel of the Acworth Police Department shall conduct themselves at all times, both on and off duty, in such a manner as to reflect the most favorably on the department. It is the policy of this agency to investigate each complaint and to take appropriate action based upon the results of that investigation. It may or may not be necessary to contact you during the course of the impending investigation into your complaint.

Any questions or rebuttal concerning probable cause, innocence, or guilt in regards to charges that may have been brought against you by this agency are for the court to hear.

Last Name *

First Name *

Street Address *

Apartment Number

City *

State *

Zip Code *

Date of Birth

Home Phone *

Work Phone

Cell Phone

Email:

Officer Name *

Incident Date *

Citation Number or Case Number *

Incident Time

Description of Incident and Nature of Complaint: *

I agree to the following statement: *

By checking the box, you are affirming that the statements contained herein are true and correct to the best of your knowledge. IT SHALL BE A FELONY TO MAKE FALSE STATEMENTS, CONCEAL MATERIAL FACTS OR TO MAKE FRAUDULENT WRITING IN MATTERS WITHING THE JURISDICTION OF THE STATE OR POLITICAL SUBDIVISIONS WITHIN THE STATE. O.C.G.A 16-10-20 (1).

Complaint Signature *

Date *

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Acworth Complaint Form Page 1/1
The purpose of this form is to report possible policy violations or improprieties on the part of Acworth Police Department personnel. Departmental policy 2.04 (II.) states that personnel of the Acworth Police Department shall conduct themselves at all times, both on and off duty, in such a manner as to reflect the most favorably on the department. It is the policy of this agency to investigate each complaint and to take appropriate action based upon the results of that investigation. It may or may not be necessary to contact you during the course of the impending investigation into your complaint. Any questions or rebuttal concerning probable cause, innocence, or guilt in regards to charges that may have been brought against you by this agency are for the court to hear.
Last Name *
First Name *
Street Address *
Apartment Number
City *
State *
Zip Code *
Date of Birth
Home Phone *
Work Phone
Cell Phone
Email:
Officer Name *
Incident Date *
Citation Number or Case Number *
Incident Time
Description of Incident and Nature of Complaint: *
I agree to the following statement: *	By checking the box, you are affirming that the statements contained herein are true and correct to the best of your knowledge. IT SHALL BE A FELONY TO MAKE FALSE STATEMENTS, CONCEAL MATERIAL FACTS OR TO MAKE FRAUDULENT WRITING IN MATTERS WITHING THE JURISDICTION OF THE STATE OR POLITICAL SUBDIVISIONS WITHIN THE STATE. O.C.G.A 16-10-20 (1).
Complaint Signature *
Date *
Upload File Here	Click here to upload file
Enter the string of characters shown in the image below. You are asked to do this in order to verify that this registration is not being performed by an automated process