BLMSM v. City of Santa Monica Contact Form

BLM Santa Monica v City of Santa Monica Contact Form

Please fill out the form below correctly
You may have deadlines or other relevant issues that impact your potential claims, if any exist, as this form creates no agreement or obligation for representation, such deadlines are solely your responsibility and you may need to consult an attorney.

Any information that you provide in this Form is private and will be held in the strictest confidence, except as needed by the Parties and the Court. It will not be provided to any Government Agency other than the Defendant. Most of the information requested is already in the possession of the Defendant through your arrest record for this protest. The information provided will be used solely for purposes of this litigation.

If you have questions about this matter, you may contact us by email at blmvsmgeorgefloydsettlement@gmail.com. You may also contact us at the mail address above and the website: http://www.blmvsmgeorgefloydsettlement.com.

The time to file a claim form has passed, this form is not a claim form and is not a substitute for a claim form.
I understood the forgoing*

Agree
Name*

First NameLast Name
Telephone*

Area CodePhone Number
Date of birth*

MonthDayYear
Date
Mobile Telephone
Work Telephone
Social Security Number
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Second Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Incident*

MonthDayYear
Time of incident*

:HourMinutesAM/PM Option
Location of Incident
be as specific as you reasonably can
Should be Empty:

BLM Santa Monica v City of Santa Monica Contact Form