Wrongful Arrest Intake Form
Please provide details about your wrongful arrest incident. All fields are for intake purposes only. Do not enter sensitive identification or financial information.
Incident Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Incident Time
*
Hour Minutes
AM
PM
AM/PM Option
Incident Location (Address or Description)
*
Arresting Agency, Officer Name, or Badge Number (if known)
Brief Description of What Happened
*
Charges or Alleged Reason for Arrest
*
Were you released after the incident?
*
Yes
No
Release Date and Time (if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Witnesses or Supporting Evidence (names, contact info, or description)
Preferred Contact Details for Follow-Up (phone or email)
*
Submit
Should be Empty: