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Internal Affairs Complaint Form
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1.
General Information
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2.
Contact Information
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3.
Complaint Information
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4.
Witness Information
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5.
Employee/Deputy Information
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6.
Submission & Legality
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7.
Signature & Affirmation
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General Information
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Contact Information
First Name
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Last Name
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Address
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City
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State
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Zip Code
Email Address
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Phone Number
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Complaint Information
Case Number (If Known)
Date & Time of Incident
Date & Time of Incident
Date & Time of Incident
Location of Incident
Nature of Complaint
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Witness Information
Witness Name (1)
Witness Phone (1)
Witness Address (1)
Witness Name (2)
Witness Phone (2)
Witness Address (2)
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Employee/Deputy Information
Employee/Deputy First Name
Employee/Deputy Last Name
Deputy Badge Number
Was the Deputy in uniform at the time of the incident?
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No
Was the Deputy in a marked or unmarked car?
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Submission & Legality
Florida State Statute 837.06 states whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in section 775.082 or section 775.083. Further, if the charges are found to be unfounded or exonerated, the accused has the right to pursue civil recourse against the complainant. When an internal investigation is concluded, that investigative file becomes open for personal inspection by any person pursuant to Florida Statute Chapter 119.
Florida State Statute 837.06 states whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in section 775.082 or section 775.083. Further, if the charges are found to be unfounded or exonerated, the accused has the right to pursue civil recourse against the complainant. When an internal investigation is concluded, that investigative file becomes open for personal inspection by any person pursuant to Florida Statute Chapter 119.
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Signature & Affirmation
Do you hereby acknowledge that the information submitted is true and accurate?
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