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- Date of Incident*
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- Complainant Date of Birth*
- Preferred Contact Method*
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Format: (000) 000-0000.
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- Is the person against whom you are requesting the complaint 18 years of age or older?*
- Can you provide the full names and addresses of the person(s) you wish to file against and any witnesses?*
- Did the incident occur in Fayette County?*
- Can you produce for identification in the form of a driver's license or an I.D. card?*
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Format: (000) 000-0000.
- Can you provide a witness statement from Witness A?
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Format: (000) 000-0000.
- Can you provide a witness statement from Witness B.?
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Format: (000) 000-0000.
- Can you provide a witness statement from Witness C.?
- Did the police talk to the witness(es)?*
- If known to you, will the witness(es) testify on your behalf?*
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- Are there any photographs of injuries, medical records, text messages, audio or video recordings of the incident/event?*
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- Are you requesting restitution? (If YES, be prepared to provide supporting documentation to substantiate your request for restitution)*
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- Should be Empty: