I, the person filling out this form, do hereby desire to file an official complaint on the named person(s) in this form.
I fully understand that any false statements that I make to the Chief of Police, the Thibodaux Police Department, or the
Internal Affairs Detective in regard to this complaint are a violation of Louisiana Revised Statue 14:133.5
“Filing a false complaint against a law enforcement officer”. Upon being convicted of filing a false complaint
against a law enforcement officer, I can be fined up to five-hundred dollars ($500.00) or imprisoned in the Parish Jail for up to
six (6) months or both.
I agree to furnish at my own expense any medical records or documents necessary to further the investigation into this
complaint. Furthermore, I fully understand that it is incumbent upon me to produce any witnesses to testify in this matter.
Failure to complete and return this form with any records and / or documents along with witness(s) information within
fifteen (15) days from the date on this form will cause this complaint to be terminated. Upon termination of this complaint,
no further action will be taken in its regard.
I fully understand that by signing this complaint, I will be required to appear and testify, if necessary, at any court session
and / or civil service hearing to which I am subpoenaed. If I fail to appear upon being subpoenaed, I understand a warrant
may be issued for my arrest.