Thurston County Sheriff's Office

Citizen Complaint Form

Complainant Name(s): *

Complainant Street Address: *

City: *

State: *

Zip *

Home Phone:

Work Phone:

Cell Phone:

Date of Incident: * +

Location of Incident: *

TCSO Members Involved:

+-

Witnesses: (Include Address and Phone Number)

+-

Incident Description: *

Complainant Signature: *

clear

Signature Date: * +

Complaint Received By:

Complaint Received Date: * +

Note: RCW 9A.76.175: Making a false or misleading statement to a public servant.
“A person who knowingly makes a false or misleading material statement to a public servant is guilty of a
gross misdemeanor. "Material statement" means a written or oral statement reasonably likely to be relied
upon by a public servant in the discharge of his or her official powers or duties.”
This complaint will be forwarded to the appropriate supervisor. The complaining party may be contacted
by the investigator during the course of this investigation. This document may be subject to public
disclosure laws

Additional Description: