All information concerning the identity of a person or group of persons making a complaint is strictly confidential and will not be released by this office unless pursuant to an order by competent judicial authority. However, such information may be shared with other governmental agencies that become involved during the course of any related investigationMississippi public employees are protected by the Whistleblower Act (M.C.A. 25-9-171 ET SEQ)
from retaliation resulting directly from truthfully testifying or providing information of improper
governmental action.

I. PERSON MAKING COMPLAINT (COMPLAINANT)

Last Name*
 
First Name*
 
Address*:
 
City*:
 
Phone Number*:
 
Email Address
 

II. PERSON(S) AGAINST WHOM COMPLAINT IS MADE (SUBJECT) *Name:

Name*:
 
Title*
 
Address/Location*
 
City*:
 
Phone Number*:
 

III. DID YOU OBSERVE THE VIOLATIONS?
YES/NO *

IV. ALLEGATIONS AND STATEMENTS OF FACTS?
COMMENTS: *
 

* In your own words, please describe the violations of law which you have observed. The description should include the alleged violation and any details relating to it, such as names, additional witnesses, dates, places, and amount of money, if known.

COMMENTS: *
 

V. I do certify that the statements mentioned in the above complaint are true and correct to the best of my knowledge and are made of my own free will. I understand that false reporting of a crime (97-35-47) or any element of a crime to any law enforcement officer or to any officer of any court is a crime punishable by one year imprisonment and payment to the law enforcement agency or court of all costs and expenses involved in the investigation of the false crime. This law is strictly enforced.