APPLICATION FORM - Stolen Lives: Killed by Law Enforcement
October 22nd - National Day of Protest to Stop Police Brutality, Repression and the Criminalization of a Generation!
Stolen Lives is a project of the October 22nd Coalition to Stop Police Brutality, the National Lawyers Guild and the Anthony Baez Foundation.
Stolen Lives Project Coalition, PO. Box 2627, New York, NY 10009, (212) 477-8062, (212) 477-8015 - fax, or visit our website: www.unstoppable.com
The mission of the Stolen Lives Project is to assemble a national list of names of people who have been killed by the police and the U.S.-Mexican border patrol. What do we want? What do the people demand? We demand justice! To contribute to the Stolen Lives list, families of victims and others who know of cases of police brutality and murder, need to fill out this form and send it to the Stolen Lives Project at the address above. (To get involved, contact the organizations listed below or the October 22nd Coalition in your area.)
(Please Print)
Name of Victim: _______________________________ Age: ____ Nationality: ___________
Date/Place of Birth: ______________________ Date/Place of Death: ___________________
Do you have a photograph of the victim? It so, please attatch it.
Lawyer(s) Name: _____________________________________ Phone No.: ______________
Address (Street, City, State and Zip):______________________________________________
What Happened?:______________________________________________________________
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Please continue on back if needed.
Please describe any legal proceedings and their outcome. Please include the names of the agencies involved and where they are located:
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Are there some things you could tell us about that victim that would help others to know him/her as a person?
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How do you want to be contacted, e.g., through your attorney, clergy, work, school or at home?
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Name: ________________________________________________________________________
Address (Street, City, State and Zip):________________________________________________
Telephone Number: _____________________________________________________________
Please include as much of the information as possible to help us verify and compile what happened.
* Photograph(s) * Police Reports * Witness Statements * Other: __________________________
Anthony Ban Foundation, 6 Cameron Place, Bronx, NY 10453, (718) 364-2879, (718) 798-2466, (718) 651-1681 - fax
National Lawyers Guild, 8124 West 3rd Street, Suite 201, Los Angeles, CA 90048, (323) 658-8627, (323) 653-3245 - fax
Oct. 22nd Coalition, National Office, P0. Box 2627, New York, NY 10009, (212) 477-8062, (212) 477-8015