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Chicago, IL 60603
(312) 676-2100
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HOME BLAKE HORWITZ SAMPLE CASES CIVIL RIGHTS QUESTIONS FREE LEGAL ADVICE FEES COMMUNITY IMPACT HELPING THE POLICE


Civil Rights Violation
Free Legal Consultation Request

Please provide the following information that forms a basis of your incident report and claim for injuries.  If we believe that we can be of assistance to you we will contact you shortly with information to assist you.

First Name
Last Name
Home Address
City
State
Zip
Title
Work Phone
Home Phone
E-mail
Date of Birth
Sex Male Female
Please explain what happened in this incident.



Some Incidents occur on only one day,
others are continuous for a period of
days, weeks or years.
Describe how you feel that you were injured.



Please povide the applicable dates in the boxes below.

Date Incident Began
Last Date of Incident

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Revised: 12/29/06