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I. Improper Arrest/Use of Excessive Force


First Name
Last Name
Address Line 1
Address Line 2
City
State
Country
Daytime Phone() -
Evening Phone() -
Fax() -
E-mail Address
Date of arrest
County of arrest
Next Criminal Court appearance
Please list the charges filed
Briefly describe your matter
Injuries suffered, if any
II.  Violation of Civil Rights (without an arrest)
First Name
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone() -
Evening Phone() -
Fax() -
E-mail Address
Claimed civil right violated
Date of violation
Entity responsible for violation?
Briefly describe your matter
Briefly describe your matter (con't)
Did you file a complaint with the EEOC? If so, what was the result?

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