Dyersburg, TN · Dyer County
Citizens Complaint Statement Form
This form lets a person provide a written statement about a complaint against the Dyersburg Police Department or one of its employees for the department to document and investigate.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The form explains how the Dyersburg Police Department receives and investigates complaints, and provides space for a complainant’s contact details and written statement. Complaints may be made in person, by mail, or by telephone; the department says people who complain by phone or mail may normally be interviewed and may be asked to provide a written, signed statement. The form does not state that every complaint must use this document.
Who needs it
A person who wants to give the Dyersburg Police Department a written statement about a complaint against the department or one of its employees may use this form.
Why it needs a notary
The supplied form text shows a signature line but no jurat or acknowledgment block; it does not say the complainant must sign before a notary.
How to get this notarized
- 1
Download the Form
Get the Citizens Complaint Statement Form and review the instructions before completing it.
- 2
Fill In Your Statement
Enter your contact details and write the information you want the Dyersburg Police Department to consider.
- 3
Check Whether Notarization Is Needed
The supplied form has no notary block. Ask the department whether it requires separate notarization before booking a notary.
- 4
Book an Online Notary if Requested
If the department separately requests notarization, book a commissioned online notary and follow their instructions.
- 5
Sign on Video if Required
If notarization is requested, wait to sign until the notary directs you during the online video session.
- 6
Submit It to the Department
Ask the Dyersburg Police Department how to deliver your completed statement.
Preview the form
The blank PDF straight from Dyersburg. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I submit a written complaint statement?
- Complete the contact information and statement sections, then contact or visit the Dyersburg Police Department to ask how to submit it. The form lists the department’s phone number and address.
- Do I need to have this form notarized?
- The supplied form text includes a signature line but no notary block and does not specify a notarization requirement. Ask the department whether it needs anything beyond the signed statement.
- Can I sign this form with an online notary?
- The supplied form has no notary block. If the department separately requests notarization, Tennessee authorizes remote online notarization by a commissioned online notary who has registered through the Secretary of State.
- Can I make a complaint without this written form?
- The instructions say complaints may be received in person, by mail, or by telephone. People who complain by phone or mail may normally be interviewed and may be asked to provide a written, signed statement.
- Where should I send the completed form?
- The form identifies the Dyersburg Police Department at 425 W. Market Street, Dyersburg, TN 38024. Contact the department about submitting the statement; confirm with the city or town if unsure.