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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