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Please give a detailed description of the incident.

Please describe the injuries sustained (physical and mental)

Date and Time of Incident?

Who was the law enforcement agency involved? (Ex. CMPD, State Trooper, Sheriffs office?)

City or County where this happened?

Is there any footage of the incident? If yes, who has it?

Have there been any public statements to media outlets about the incident?

Did you recognize any of the officers involved in the incident or have you had previous contact with officers?

Did you seek medical attention after the incident? If so, where, when, and of what nature?

Were any weapons used or threatend to be used by law enforcement or yourself?

Were you in possession of a weapon at the time of the incident?

Did you strike or attempt to strike law enforcement?

Did you attempt to resist police officers?

Did you say anything that could be considered rude, questioned their authority or said or did anything anything that could possibly be construed as provocation? If so please state the nature.

Did you or any other person make a citizen's complaint concerning the incident to Internal Affairs, a citizen's review commission or any other police investigating body? If so please what statement was given and to whom.

What is your theory as to why the police abused you?

How did you find our firm?

How have you been impacted by this incident?

In any civil case, you must show damages. Please describe any financial, mental or professional losses you have experienced as a result of the incident. (Ex. Lost time from work, fired, therapy costs, medical costs, decline in health etc.)

POLICE MISCONDUCT RETAINER FORM

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