City of Sonora Complaint Form

City of Sonora Complaint form

Person Filing Complaint:
Name Address City

State Zip code Home Phone

Work Phone Employer Address

City State Zip

May we Contact you at Work, if necessary? yes no

Did you receive any assistance in filling out this form? yes no

If yes, please provide name and relationship of person providing the assistance

Name

Relationship

Employee Involved:
Name(if known) Position or Assignment

Was City Equipment Involved? yes no

If yes, what equipment?

Complaint
Briefly Describe the nature of the complaint

Date and time of incident
Location of Incident
Name and Address of all Witnesses to Incident
1.
2.
3.
Please provide a detailed and accurate narrative account of the incident below

I, being of age, do of my own personal knowledge make the following statements and declare them to be true. Signed under the pains and penalties of perjury this day of ,20

___________________________________
__________________,20______________.

Then personally appeared

before me, who executed the foregoing affidavit before me.

Notary Public

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