Complainant's name(*)
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What is your age?
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What is your race?
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Tel. Number e.g. 212-777-9311
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Address (City,State,Zip)
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Name of the police department if you know it
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Your Zip Code
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What is your state
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Time of the Police Interaction
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Email Address (*)
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Briefly describe what happened
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The primary reason for your complaint is
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If you had to choose the three most serious offenses that the officer is accused of which would it be among the following choices?
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Race of the officer
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What is the officer's name or badge number?
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Were you arrested?
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Do you want assistance with your complaint?
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