|
OFFICE OF THE SCOTT
COUNTY ATTORNEY
400 W. 4th Street
Davenport, IA 52801
(563) 326-8600
CRIMINAL COMPLAINT
AND REFERRAL
|
| To
file a complaint with the County Attorney’s Office, you
must fill out this form COMPLETELY and return
it to the receptionist between the hours of 8:30 a.m. and 11:30
a.m., Monday through Friday. At that time, you will be able
to discuss your case with an attorney who will advise you about
the case and your rights. |
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INFORMATION ABOUT YOU
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PERSON COMPLAINING ABOUT
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| Name |
|
Name |
|
| Address |
|
Address |
|
| |
|
| Home
Phone |
|
SSN |
|
DOB |
|
| Work
Phone |
|
Ht |
|
Wt |
|
Hair
|
|
| SSN |
|
Eye
Color |
|
Race |
|
| DOB |
|
Place
of Employment |
|
| If
this is a business complaint, the name and address of thebusiness
should be used above, and your name and title below. |
You
must provide sufficient identifiers for us to enter awarrant
into the computer system before we can issue a warrant for anyone.
Get as much of the above information as you can before applying
for a warrant. |
| Name |
|
| Title |
|
| Have
you ever filed a complaint against this person before? Yes No |
|
What type and when?
|
|
| Has
this person ever filed a complaint against you? Yes No |
|
What type and when?
|
|
| Have
you filed a report with the Police? Yes No |
If
yes, when filed |
|
| Report
No |
|
Department |
|
Officer,
if known |
|
| Date and Time
of Incident |
|
| Location of Incident |
|
| Brief
Summary of FACTS: (THIS MUST BE COMPLETE. Use back of
form if necessary). |
|
|
| Witness Name:
|
Witness Address: |
| Your Signature |
|
Date |
|
| Complaint # |
|
ACA |
|
Disposition |
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