I do hereby affirm that the above information provided by me is true and complete to the best of my knowledge
and belief. I understand that any false, misleading or untrue statements,
accusations or allegation herein made by me in relation to this complaint, either orally or in writing, to any person or persons
investigating this complaint may subject me to civil and/or criminal prosecution.
I fully realize that it may become necessary in the investigation of this complaint for me to meet with a
member or members of Whitehall Police Department to discuss this complaint. I
agree that should any Administrative Hearing or Court proceedings result from the Investigation of my complaint, to make myself
available to present testimony at such hearings if requested to do so.
THOSE WHO SUBMIT IDENTIFICATION / INFORMATION FOUND TO BE FALSE WILL BE SUBJECT TO CIVIL / CRIMINAL PROSECUTION.
Whitehall Police Department
57 Skenesborough Drive, Whitehall, NY 12887
Non-Emergency Phone (518)499-1316
Emergency - Dial 911
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