Contact
Information: Name
Address
City/State/Zip
Phone (Day)
Phone (Evening)
Email:
Privacy Requirements :
No
Release (Internal ACSL Policy Use ONLY)
Legislators ONLY
No
Restrictions
Witness(es) :
Names and contact information (if available)
Agency :
Along with officer names and identifying
information (i.e. badge number, car number, 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?