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Report of Racial Profiling by MCSO

Please specify if this was before or after December 2011:


______

Before

______

After

Name of person racially profiled: __________________________________________


Approximate Date of incident: ___________________________________________
Phone number: __________________ Email: __________________________ _____
Were you given a citation (ticket)?

Yes

No _

Do you have a copy?_Yes

No_

What are you charged with? ______________________________________________


Were you Handcuffed or Arrested?

Yes

No ______________________

__

Location/address of incident (best estimate): _________________________________

Where you asked about your legal status?

Yes

Were passengers in the car asked about their legal status?


Additional notes:

When form completed please mail to:


Somos America
C/O Respect Respeto
P.O Box 4066
Phoenix, AZ 85030

No__________________
Yes

No___________

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