Interviewed By:____________      Video: yes_____ no______          Date:____________





Print Name:                                                      Signature: ________________________________________________________________________





Contact: ________________________________________________________________________

(phone, email, message)


When describing an incident, provide as much detail and basic facts as possible:

Say simply what happened and do not make it too wordy, but make sure you write down the facts: give date and time, give location with street names, print names and contact information of witnesses, print number on police car and descriptions or names of police officers or city employees, and provide any paperwork when possible. Write the ticket citation number, violation number, the court name and your court date (or provide a copy or the ticket).






















Justice Committee,   P.O. Box 2881, Venice CA  90294

Email  Phone 310 365 0985