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LANSING POLICE DEPARTMENT     
COMPLAINT AGAINST DEPARTMENT EMPLOYEE

(the form below is for viewing purposes only, please read the instructions at the top of this page to access a printable form.)

Complainant Information:

RD Number:                                    
Name:                                                                                                                       Date of Birth:                                 
Home Address:                                                                                                                     
Employer Address:                                                                                                          
Home Phone:      Work:                                    Cell:                                 
Location of Incident:  
Incident Date:                                                                    Time of Incident:   Date Complaint Filed:                                   
Supervisor Receiving Complaint:            
                 
Name of Person(s) Complaining About:
1)         3)        
2)         4)        
                                                                                                                                                     
Witnesses who actually saw and were present at the incident:
Name     Address       Phone Number  
     
     
     
Please print a summary of complaining incident:
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
Revised 11/03/06                                                                                                          (Continued on other side)
 

 

Continuation of summary:
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                     
                                        Please read before signing                                          
It is the policy of the Lansing Police Department to thoroughly investigate all complaints against employees of the Department. 

Illinois Law requires all complaints be supported by sworn affidavit. 

As such, you will be required to sign this complaint under oath or affirmation. If the results of the investigation reveal you knowingly provided false information, you may be subject to criminal prosecution.
   
                                                                                                                                              
 (Original Complaint's Signature)                                                 (Complaint's signature sworn under oath stating that this complaint       
has been read by him/her and that this complaint is true)
Signed and sworn to before me as a notary public of Cook County, Illinois this ____ day of ________, 200___
__________________________
 Notary Public Signature STAMP

(the form above is for viewing purposes only, please read the instructions at the top of this page to access a printable form.)