CITIZEN'S COMPLAINT FORM

CHARLES R. GUILLORY

SHERIFF & TAX COLLECTOR

200 COURT ST SUTIE 100

VILLE PLATTE, LA 70586

PHONE: 337-363-2161

FAX: 337-205-5866

CITIZEN'S COMPLAINT FORM

COMPLAINT NUMBER: ___________________________________________

[{"type":"paragraph","subtype":"p","label":"Per State Law 14:133.5, filing a false complaint against a law enforcement officer is knowingly filing, by affidavit under oath,, a false statement or false representation with a law enforcement agency regarding the conduct, job performance, or behavior of a law enforcement officer to initiate an administrative action against that law enforcement officer. Per current EPSO policy, complaints must generally be made within 60 days of the incident unless special circumstances exist. Witnesses may also use this form to provide information on incidents.","className":"d-block"},{"type":"text","required":true,"label":"NAME","name":"FULL-NAME","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"COMPLAINANT","name":"COMPLAINANT-NAME","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"RACE:","name":"RACE","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"SEX:","name":"SEX","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"DATE OF BIRTH","name":"DOB","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"DRIVER'S LICENSE NUMBER","name":"DL-","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"HOME ADDRESS","name":"PHYSICAL-ADDRESS","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"CITY","name":"CITY-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","required":true,"label":"State","name":"State","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL","selected":true},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","required":true,"label":"ZIP","name":"ZIP","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"CONTACT PHONE NUMBER:","name":"PHONE","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"EMAIL ADDRESS","name":"EMAIL","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"DATE OF INCIDENT:","name":"INCIDENT-","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"ADDRESS OF INCIDENT:","name":"ADDRESS","className":"col-md-6","subtype":"text"},{"type":"textarea","required":true,"label":"In your own words, describe the exact nature of your complaint. Begin with the date and location of the incident then construct the facts in chronological order. (Include description of Deputy's Name and Badge number if known).","name":"description","subtype":"textarea","className":"d-block"},{"type":"text","required":true,"label":"SIGNATURE","name":"NAME","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"DATE:","name":"DAY","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"Ways to register our complaint:<div><br></div><div>SUBMIT THROUGH THIS SITE OR:<div>Print this form and </div><div>EMAIL: evangelineso@evangelineparishsheriff.org</div><div>FAX: 337-205-5866</div><div>MAIL: Capt Monica Reed</div><div>           415 W Cotton St.</div><div>           Ville Platte, LA 70586</div></div>","className":"d-block"}]