Lebanon, TN Police Dept.

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Site Name

Lebanon Tennessee Police Department

Phone

(615) 444-2323

Tagline

Protect with Courage – Serve with Compassion

Lebanon Police Department Report of Complaint Against Police Personnel

Lebanon Police Department Report of Complaint Against Police Personnel

Lebanon Police Department Report of Complaint Against Police Personnel
Today's Date *
Supervisor Receiving *
Incident Date and Time *
Officer's Name/Badge
Complaint against Officer *
Location of Complaint *
Your Name
Complainant *
Date of Birth *
Phone Number *
Address *
City *
State *
Zip code *
Business *
First M. Last
Victim Name *
Date of Birth *
Phone Number *
Address
City
State
Zip Code
First M. Last
Victim Name *
Date of Birth *
Phone Number
Address
City
State
Zip Code
First M. Last
Witness Name *
Date of Birth *
Phone Number *
Address
City
State *
Zip Code *
First M. Last
Witness Name
Date of Birth
Phone Number
Address
City
State
Zip code
Nature of Complaint *
By checking the "I agree" box below, you do hereby certify that the above report is true and correct as best as I can present the facts pertinent to this complaint. I understand that under the regulations of the Lebanon Police Department, the employee whom this complaint is filed may be summoned to appear at an Administrative Hearing. By signing this complaint I agree, if necessary, to appear at the hearing and testify under Oath concerning all matters relevant to this complaint. I also understand that a written record of all testimony will be made and a copy will be furnished to the employee and their attorney. If a hearing is held, the employee and their attorney have a right to be present and to cross-examine me concerning any testimony I might give.

NOTICE: IT IS UNLAWFUL FOR ANY PERSON OR PERSONS TO REPORT TO A LAW ENFORCEMENT OFFICER AN OFFENSE OR INCIDENT THAT DID NOT OCCUR. (TCA 39-16-502)

Electronic Signature Agreement *
I Agree
First M. Last Date and Time
Signature of Complainant
Signature of Officer Receiving Complaint
Lebanon Police Department Report of Complaint Against Police Personnel Supplemental Narrative
Complainant Initials *
Date *
Reporting Officer's Initials
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