NYPD Protest Response Form Submitter information Full name Street address City/town State - None -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip code Phone number Email Race/ethnicity (optional) - None -AsianBlack or African AmericanHispanic or LatinoNative AmericanNative Hawaiian or Pacific IslanderWhite Interaction details Were you physically present to witness or experience any alleged misconduct by any NYPD officer(s) during the protest? Yes No How were you involved? I was directly involved in interactions with NYPD officer(s) I witnessed others’ interactions with NYPD officer(s) Direct involvement Was any physical force used against you by any NYPD officer(s) during the protests? Yes No Force details Select the type of force used Baton or nightstick Bike Firearm Hand/body strike Patrol Car Pepper spray Taser Other Other type of force Select the type of physical injury sustained, if any. Check all that apply None Abrasion Bleeding Broken or fractured bone Contusions Substantial pain or injury requiring hospitalization Other Other type of physical injury Where and at what time did the incident you experienced occur? Borough - Select -BronxBrooklynManhattanQueensStaten IslandOutside NYC Intersection Police precinct - None -5th Precinct1st Precinct6th Precinct7th Precinct9th Precinct10th Precinct13th PrecinctMidtown South Precint17th PrecinctMidtown North Precint19th Precinct20th PrecinctCentral Park Precinct23rd Precinct24th Precinct25th Precinct26th Precinct28th Precinct30th Precinct32nd Precinct33rd Precinct34th Precinct40th Precinct41st Precinct42nd Precinct43rd Precinct44th Precinct45th Precinct46th Precinct47th Precinct48th Precinct49th Precinct50th Precinct52nd Precinct60th Precinct61st Precinct62nd Precinct63rd Precinct66th Precinct67th Precinct68th Precinct69th Precinct70th Precinct71st Precinct72nd Precinct73rd Precinct75th Precinct76th Precinct77th Precinct78th Precinct79th Precinct81st Precinct83rd Precinct84th Precinct88th Precinct90th Precinct94th Precinct100th Precinct101st Precinct102nd Precinct103rd Precinct104th Precinct105th Precinct106th Precinct107th Precinct108th Precinct109th Precinct110th Precinct111th Precinct112th Precinct113th Precinct114th Precinct115th Precinct120th Precinct121st Precinct122nd Precinct123rd Precinct NYPD Precinct finder Date Estimated time Include any other details about what led to the use of force, the force used, and resulting injuries, if any Witness Did you personally witness any physical force by any NYPD officer(s) during the protest? Yes No Witness force details Select the type of force used. Check all that apply Baton or nightstick Bike Firearm Hand/body strike Patrol Car Pepper spray Taser Other Other type of force Select the type of physical injury sustained, if any None Abrasion Bleeding Broken or fractured bone Contusions Substantial pain or injury requiring hospitalization Other Other type of physical injury Please include as much detail as possible, including what occurred, what led to the use of force, the officer(s) involved, and any injuries you witnessed. Where and at what time did the incident you experienced occur? Borough - Select -BronxBrooklynManhattanQueensStaten IslandOutside NYC Police precinct - None -5th Precinct1st Precinct6th Precinct7th Precinct9th Precinct10th Precinct13th PrecinctMidtown South Precint17th PrecinctMidtown North Precint19th Precinct20th PrecinctCentral Park Precinct23rd Precinct24th Precinct25th Precinct26th Precinct28th Precinct30th Precinct32nd Precinct33rd Precinct34th Precinct40th Precinct41st Precinct42nd Precinct43rd Precinct44th Precinct45th Precinct46th Precinct47th Precinct48th Precinct49th Precinct50th Precinct52nd Precinct60th Precinct61st Precinct62nd Precinct63rd Precinct66th Precinct67th Precinct68th Precinct69th Precinct70th Precinct71st Precinct72nd Precinct73rd Precinct75th Precinct76th Precinct77th Precinct78th Precinct79th Precinct81st Precinct83rd Precinct84th Precinct88th Precinct90th Precinct94th Precinct100th Precinct101st Precinct102nd Precinct103rd Precinct104th Precinct105th Precinct106th Precinct107th Precinct108th Precinct109th Precinct110th Precinct111th Precinct112th Precinct113th Precinct114th Precinct115th Precinct120th Precinct121st Precinct122nd Precinct123rd Precinct NYPD Precinct Finder Date Estimated time Additional interactions Did you witness or experience other alleged misconduct by NYPD during the protest? Yes No Additional info details Select the types of alleged misconduct you witnessed or experienced Biased policing False arrest Use of offensive language or discourtesy Lack of mask/personal protective equipment Obstructed shield/badge Unjustified stop and/or frisk Other Other type of alleged misconduct Please include as much detail as possible, including what occurred and the officer(s) involved Complaint and legal action Have you made a complaint regarding the incident(s) you describe above to any other agency (e.g., Civilian Complaint Review Board, City Commission on Human Rights)? Yes No Which agency? Have you filed any legal action against NYC or the NYPD arising out of the information you provided? Yes No Please provide the court and case number Status Submit up to 5 supporting photographs of the incidents you describe above. Please note that each file must be smaller than 10 MB and combined file size of all attachments may not exceed 50 MB. To share video files, see the “Links to Video” section below. How many files would you like to upload? File attachment 1 Supporting photo 1 One file only.10 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, psd, txt, pdf, doc, docx, ppt, pptx, xls, xlsx. I am the owner of this file I do not know the owner of this file I know the owner of this file File attachment 2 Supporting photo 2 One file only.10 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, psd, txt, pdf, doc, docx, ppt, pptx, xls, xlsx. I am the owner of this file I do not know the owner of this file I know the owner of this file File attachment 3 Supporting photo 3 One file only.10 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, psd, txt, pdf, doc, docx, ppt, pptx, xls, xlsx. I am the owner of this file I do not know the owner of this file I know the owner of this file File attachment 4 Supporting photo 4 One file only.10 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, psd, txt, pdf, doc, docx, ppt, pptx, xls, xlsx. I am the owner of this file I do not know the owner of this file I know the owner of this file File attachment 5 Supporting photo 5 One file only.10 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, psd, txt, pdf, doc, docx, ppt, pptx, xls, xlsx. I am the owner of this file I do not know the owner of this file I know the owner of this file Status Submit up to 5 supporting videos of the incidents you describe above. To share video files, please upload to a third-party video site -- such as YouTube, Vimeo, Twitter, Instagram, or Facebook -- and provide the direct link to the content and a brief description of the nature of the video below. How many videos would you like to link to? Video link 1 Full link to video Description of content I am the owner of this video I do not know the owner of this video I know the owner of this video Video link 2 Full link to video Description of content I am the owner of this video I do not know the owner of this video I know the owner of this video Video link 3 Full link to video Description of content I am the owner of this video I do not know the owner of this video I know the owner of this video Video link 4 Full link to video Description of content I am the owner of this video I do not know the owner of this video I know the owner of this video Video link 5 Full link to video Description of content I am the owner of this video I do not know the owner of this video I know the owner of this video In providing the Attorney General's Office this information, I understand that: Note: All boxes much be checked before submission The Attorney General is not my private attorney but represents the public in enforcing laws. My providing this information does not mean the Attorney General has initiated a lawsuit or proceeding on my behalf. The Attorney General cannot give me legal advice or represent me in court. If I have questions concerning my legal rights or responsibilities, I should contact a private attorney. The Attorney General may use my statement regarding my interactions with the NYPD during recent protests and any other documents, photographs, videos and/or other information I provided related to this investigation in a public document, including in a legal proceeding or public report or statement. I understand that if I wish to file a complaint with the New York City Civilian Complaint Review Board, I have to reach out to that agency directly.
