Please provide detailed information regarding your experience being reported. Attach as many pages necessary to describe the
incident. Please be sure to sign your statement. The following information may or could be used in the filing of a criminal
complaint. Should an individual make a false statement with the intent to deceive a peace officer conducting an
investigation and the statement is material to the investigation, an individual could be prosecuted for the criminal
offense of False Report to a Peace Officer under Section 37.08 of the Texas Penal Code.
