Report!!

Police Officers
Attorneys
Judges
Other Government Employees
Business Organizations - Business Employees
Property Owners/Renters
Academic Officials, Employees, or Students
Other Non-government Organizations/Personnel

acting under color of law, or putatively occupying their positions under color of law, or both.(Note: The phrase "under color of law" as used in this report includes, but is not limited to the meaning of the same phrase "under color of law, statute, ordinance, etc., used in 18 U.S.C. 242 and 42 U.S.C. 1983 .If a person oppresses somebody under claim of *any* sort of legitimacy, such as land ownership, let's include that too. The technical legalities can be adjusted later.)

Specify to who:

1. Date of incident/offense:

2. Time of incident/offense (include A.M. or P.M.):

3. Location of offense (street address or commonly known building, location, etc):

3a. City, State, Country:

4. Identity of offender (eg. name, ID#)

4a. Offender's employment position:
operating under color of law.

5. Name of offender's organization:

operating under color of law (Note: The organization may be regarded as a separate offender).

6. Briefly state what the offender(s) did. If the offender issued a citation, include the statements contained in it. If you were confronted by the police, be sure to indicate if the police told you specifically who called them, and who the callers were.

6a. Is the offender guilty of prior offenses involving the same victim? If such information is known, you may use a separate form to describe the prior offenses, and explain here:

7. (Optional) Which laws were violated? (example "18 U.S.C. 242 - U.S.C.A. 4: unreasonable search or seizure, seized homeless belongings under color of ordinance....Indicate common-law analogies such as theft, robbery, fraud, assault, battery, disturbing the peace, kidnapping, perjury, etc., as if the offender had not been fraudulently acting under color of law. For a list of helpful ideas use this HTML link.

8. Physical description of offender: Height, Weight, Gender, Color, Color Hair, Color Eyes, Clothes, Age:

9. Identity of victim

10. Vehicle used by offender? (description, lic #):

11. Radio transmitter or other telecom devices used by offender (description - radio, cellphone, radio ID, etc.):

12. Firearms used by offender (Describe. If firearms were present, indicate if brandished or holstered):

13. Describe other weapons present (eg. billyclubs. Indicate if brandished):

14. Nature of reporting party's contact with offender:
observed but no contact
First-hand contact with offender
Present while others victimized by offender
No first-hand contact, but information supplied by third party.
Other (describe):

Citizens' Arrest Information, if applicable:

15. Did the offender refuse to answer questions, resist citizens' arrest? If so, explain below.

16. If you took the offender into custody, state where: (eg. to U.S. Marshall's office or local citizens' militia)

17. Were offenders' weapons, radios, or vehicles seized during citizen's arrest? If so, identify them and indicate where they are being stored.

18. Post-secondary academic degrees/occupational licenses (etc.) of offender (state from where, dates):

18a. Post-secondary academic degrees/occupational licenses (etc.) of victim (state from where, dates):

19. (Optional) Do you feel that the courts, the attorneys, etc., would handle the situtation justly?

Yes

No

19a. (Optional) If your answer is "No", you may Click here to link to an additional questionaire which includes common reasons why the courts may not handle the situtation justly.

20. Please identify yourself and your occupation.

21. How can you be contacted?

22. Recommendations:
Repramand
Suspension
Transfer
Demotion
Discharge/Removal
Lien on Property
Professional/License Sanctions
Injunction
Civil Monetary Liability
Criminal Liability
Other: (explain in next section)
Don't know

22a. Include additional statements of fact here or attach additional pages if this form is completed on hard-copy). Include names, etc. of other witnesses and other offenders involved. Include recommendations, possible remedies, description of damages, injuries, etc.

23. This document is an:

Original report
Amended report

24. Declaration: My name is

and I declare under penalty of perjury that the statements submitted in this form are true to the best of my knowledge and information.

25. Today's Date:

Or send to:

D.H. Myers
P.O. Box 213
Palo Alto, CA 94302