Name Address City, State, Zip Phone email Date (mm/dd/yyyy) What was your experience? Witnesses - Names & contact information if possible. Agency - Along with Officer names and identifint information (ie. Badge #, Car #, number of officers etc.
Officer/Agency Situation Demeanor :
Professional
Courteous & Polite
Officious & Overbearing/Gruff
Rude & Offensive
Threatening
Dismissive & Cavalier
Unhelpful
Supporting Documentation Availability :
I am willing to supply the documentation available to me as part of this incident
Documentation must be kept private
No documentation is available
Legal Situation :
An attorney is involved
No attorney is involved
Need to get an attorney
Attorney Recommendation requested
I do not want to get an attorney
Status of Incident :
Have contacted my state legislator
Resolved
Impasse
Not sure what to do next
Firearm seized and not returned
ALL my firearms were seized and not returned
No receipt given by Law Enforcement (as *required by PA Law [6105 (f)(4))
May we contact you for more information?
Privacy Requirements :
No Release (Internal ACSL Policy Use ONLY)
Legislators ONLY
No Restrictions