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Information About You

Information About The Event
Date and Time*
Date and Time Start Date
Date and Time Start Time
—
Date and Time End Date
Date and Time End Time
Please tell us when the event occurred. If you are not certain please give us your best estimate.
Where did this occur?*
Do you know the names of the Hanover Police Department employees involved?*
Employee #1
Employee #2
Employee #3
Other than you, were there other witnesses or involved parties?*
Person #1 Name
Person #1 Phone/Email
Person #2 Name
Person #2 Phone/Email
Person #3 Name
Person #3 Phone/Email
Statement Instructions
Please summarize the event in as much detail as you can recall. If the names of employees, involved persons, or witnesses are unknown please give a detailed description.
Statement*
Electronic Signature Agreement*
By checking the "I agree" box below, 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.
1. I agree.
Electronic Signature*
Today's Date*
Today's Date

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