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First, Last and Middle
Please provide us with detailed information regarding this matter in your own words.
By typing your name, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Put Name, ID and Date
Please put if this was given in person, over the phone, or by some other method.
I hereby certify that on the date provided, I appeared before a district commissioner or notary public of the State of Maryland and the County submitted, and made an oath in due form of the law that the matters and facts provided in a case of police brutality are true.
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