Citizen Complaint Against TPD Department Member

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FOR EMERGENCIES DIAL 911

Postal Address:

P.O. Box 5418
1309 Canal Blvd.
Thibodaux LA, 70302

Fill out the form to the best of your abilities. When done, click on 'Generate PDF Form' and the document will be generated for you to print out, sign, and submit to TPD.

By using this service, you are agreeing to the terms and conditions listed here.

Note:

The data you enter here is not saved in our system at any point during the submission of this form.

Having trouble with the form? Click here to fill out the PDF directly.

Complainant Name:

Complainant Social Security Number (SSN):

Complainant Home Address

Complainant Primary Phone Number:

Complainant Employer:

Complainant Business Phone Number:

Date, Time, and Location of Incident:

Name of Person(s) You Are Complaining About, If Known

Person #1:

Person #2:

Person #3:

Person #4:

Has this incident been previously reported?

If you answered 'Yes' before, then who did you report the incident to?

Person(s) Who Actually Saw The Event (Including Self)

Witness #1:

Witness #1 Address:

Witness #1 Phone Number:

Witness #2:

Withness #2 Address:

Witness #2 Phone Number:

Witness #3:

Witness #3: Address:

Witness #3: Phone Number:

Summary of Incident (If you need more room, the PDF has extra lines on page #3)

3658 character(s) left.

I agree to the terms and conditions stipulated here and on the generated form.

Please Read The Text Below Carefully.

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.

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