Incident Form

Your Full Name
Only to contact you regarding the outcome of your case.
Address
MM slash DD slash YYYY
Time of Incident
:
Accepted file types: jpg, jpeg, png, bmp, gif, tiff, heic, jpg, jpeg, png, pdf, doc, docx, txt, mp4, mov, avi, Max. file size: 10 MB.
Clear Signature
By signing and submitting this form, you certify that you understand and expressly consent to the potential disclosure of any statements, accusations, or information provided as a public record under the California Public Records Act (California Government Code Section 6250 (/statute/california-codes/california-government-code/title-1-general/division-7-miscellaneous/chapter-35-inspection-of-public-records/article-1-general-provisions/section-6250-legislative-intent) et seq.), except where exempt from disclosure under applicable law. You acknowledge that such information may be accessible to the public or other parties as permitted by California law.