Citizen Complaints Committee

Who: Your Name: _______________________________________________________________________ Address: __________________________________________________________________________ City, State, Zip, Code: _______________________________________________________________ Telephone: ( ) Extension: ______________

What: Subject of Complaint. Briefly state the nature of complaint and the action of what Los Angeles County department, section, agency, or official(s) that you believe was illegal or improper. Use additional sheets if necessary. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________

When: Date(s) of incident: __________________________________________________________________ _______________________________________________________________________________________________

Where: Names and addresses of other departments, agencies or officials involved in this complaint. Include dates and types of contact, i.e. phone, letter, personal. Use additional sheets if necessary. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________

Why/How: Attach pertinent documents and correspondence with dates. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 2005 – 2006 County of Los Angeles Civil Grand Jury 309 Rev.05/03/06 310 2005-2006 County of Los Angeles Civil Grand Jury County of Los Angeles CIVIL GRAND JURY CLARA SHORTRIDGE FOLTZ CRIMINAL JUSTICE CENTER 210 WEST TEMPLE STREET • ELEVENTH FLOOR • ROOM 11-506 • LOS ANGELES, CALIFORNIA 90012 TELEPHONE (213) 893-1047 • FAX (213) 229-2595 http://www.grandjury.co.la.ca.us/ (Date) (Name and address of complainant) Dear (Name of complainant): Your letter to the Civil Grand Jury, dated (date), has been received. The Civil Grand Jury’s review of this matter does not mean that the Grand Jury will conduct a full investigation into your complaint. You will not receive any further communication from the Grand Jury. By law, the Grand Jury cannot communicate the results of investigations to you personally. Reports of the Grand Jury investigations are available to the general public when published. Please note that the Los Angeles County Civil Grand Jury has no jurisdiction or authority to investigate Federal agencies, State agencies, or the Courts. Only local governments within Los Angeles County are subject to Grand Jury review. Sincerely, Grand Jury Staff sjp 2005 – 2006 County of Los Angeles Civil Grand Jury 311 312 2005-2006 County of Los Angeles Civil Grand Jury CONTINUITY Dick Lewis, Vice Chair Michael Roberts, Secretary Patricia Baraz Beverlee Bickmore Richard Niederberg Zelda Plotkin 2005 – 2006 County of Los Angeles Civil Grand Jury 313 314 2005-2006 County of Los Angeles Civil Grand Jury CONTINUITY COMMITTEE