This form is provided to assist citizens with the formal Internal Affairs complaint process. Witnesses may also use this form to provide information on incidents. Personnel complaints will be handled in accordance with Texas Government Code 614.021, 614.002, and 614.023. A name, signature, email address, or phone number are required. Full Name: * Are you the Complainant? * Yes No Are you the witness? * Yes No Home Street Address: Apt/Unit Number: City: State: Please select your stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Office Address: City: State: Please select your stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Contact Phone Number: Best Time to Call: E-mail Address: Date of Incident: * Time of Incident: Location of Incident or Address of Incident: Have you contacted the employee’s supervisor or anyone else in the department? * Yes No If yes, who did you contact? Provide the name of the employee(s) or a description of the employee(s) involved in the incident. Were you arrested? * Yes No Did you receive a citation or service number? * Yes No If yes, what is the citation or service number? Does this involve an incident at one of the jails? * Yes No If yes, what jail? List any witnesses who saw the incident and their telephone numbers or email addresses. 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