C I T Y O F A T L A N T A

Kasim Reed	226 Peachtree Street, SW	Atlanta Police Department
Mayor	Atlanta, Georgia 30303	George N. Turner
(404) 546-6900	Chief of Police

GRIEVANCE WITHDRAWAL FORM

DATE: ______________

DEPARTMENT: ____________________	BUREAU: ____________

NATURE OF GRIEVANCE

I, _____________________________, do hereby voluntarily and without coercion, withdraw

my grievance. It has been explained to me and I fully understand that upon signing this document I waive all rights to grieve on these specific charges at any future date.

___________________________________________________________________________

Signature of Employee

________________________________________________________________________

Signature of Supervisor

APD Form 237

vlivsey

2011-01-06