ATLANTA POLICE DEPARTMENT

RELIEF FROM DUTY

OPS CONTROL #:

TO:
FROM:
DATE:
RE:
Relief From Duty Notice
You are hereby suspended from duty with pay effective
for the following reason(s):
(Give specific reason(s); also, state any conditions and restrictions concerning the suspension with pay. Include the restriction prohibiting all extra job employment.)

REASON:

CONDITION:

You will provide a home telephone number and any pager number where you may be reached. You will make yourself available for interview Monday through Friday from 0900 to 1700. Should you be away from your listed home phone number for more than two (2) hours during this time, you will contact and advise _______________________ of the Office of Professional Standards where you can be reached. If he or she is unavailable, you will then advise a supervisor at OPS of the information. You are forbidden to work any extra jobs during your relief of duty.

EMPLOYEE TELEPHONE NO.

PAGER:

This notice acknowledges receipt of the following Departmental property relinquished by you:

(List inventory and description of property; include serial number of weapons, badge number, etc.)
ITEM NO.	DESCRIPTION (Include model & serial number, if applicable)	QUANTITY

_________________________________________

AFFECTED EMPLOYEE'S	DATE/TIME

SIGNATURE

___________________________________________

WITNESS SIGNATURE	DATE/TIME

P - ______ - ______ - ______

Form APD-828 revised 1/1/2000

ATLANTA POLICE DEPARTMENT

VWarnic

2003-12-29

AJordan

APD