MAINE CIVIL LIBERTIES UNION FOUNDATION

Today’s Date_________________________

Your Name__________________________

Address_____________________________

City________________Zip_____________

Home Phone_________________ Work Phone (if OK to call)______________________

We strongly recommend that you not discuss your complaint with the news media while the MCLU is reviewing your complaint. (If we accept your case, your assigned attorney will speak to the press on your behalf.) Take time to answer questions fully. Use extra paper if necessary.

1. List all the parties involved in your complaint. It is important that you take time to do this. For example: Myself, Jane Doe. My witness, Ann Doe. Anytown Police Officer John Smith. Anytown Police Chief Richard Brown.

2. Describe in your own words what happened to you, including dates, places, and who did what. Enclose copies of documents relevant to your complaint. We cannot return documents to you. Use extra paper or back of this paper if necessary.

3. Were you given any explanation for what happened? If so, what was the explanation? Why do you think this happened to you?

4. Have you done anything on your own to try and solve the problem (for example, filed an appeal, complained to the agency involved, written to a public official)? If so, what was the result?

5. What do you want the MCLU to do for you? Please be specific.

6. Have you already gone to another agency for help? If so, what was the agency? Is the agency assisting you? If not, what was the reason given?

If you are willing to have us call the agency to discuss your complaint, you must sign the following statement: I authorize an agent of the Maine Civil Liberties Union to discuss my complaint with any agency from which I have sought assistance in the matter described in Question 2 above.

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Signature/Date

7. Have you consulted an attorney about this matter? Consulted_____ Hired______

Name of attorney______________________________________. If you wish to contact the attorney for more information, you must sign the following statement: I authorize an agent of the Maine Civil Liberties Union to discuss my complaint with any attorney whom I have consulted in the matter described in Question 2 above.

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Signature/Date

Please return this form to: MCLU, 401 Cumberland Avenue, Portland, Maine 04101