Occupy Legal Info Request

If you have been arrested, cited, or detained, please provide the following information.

If possible, provide this information directly from the citation, arrest record, or other documentation. Note: This info will be compiled in a private area (not publicly viewable).

YOUR INFORMATION

• Your full name (Last, First Middle):
• Your address (or "none"):
• City State Zip:
• License or ID State
• License Number
• Date of Birth
• Gender: [ ]M [ ] F
• Your Phone #1:
• Your Phone #2:
• Email:

ARREST / CITATION / DETAIN INFORMATION

• Law Enforcement Dept [ ]SDPD [ ]SD Sheriff [ ] Harbor Police [ ] Other :____________________|
• Booking/Citation Number:
• Date of arrest/citation/detain:
• Time of arrest/citation/detain:
• Case Number:
• Violation Description:
• Violation Location:
• Officer Last Name:
• Officer First Name:
• Badge Number:
• Court Date:
• Your Comments:
• Disposition:
• Total time detained:
• Taken to Jail?

COMPLAINTS

• Complaint Made?
• Complaint Number:
• Complaint Date: