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Video Identification

Location Of Video

Address Line 1

City

State

Zip Code

Description Of Location

School, Park, College, Office etc.

Description of Incident

Name of individual(s) in Video (Specify if Assailant = A Victim = V)

Name for Victim/Assailant 1

Contact Info for Victim/Assailant 1

Info for Victim/Assailant 1

Name for Victim/Assailant 2

Contact Info for Victim/Assailant 2

Info for Victim/Assailant 2

Personal Info

Name *

First

Last

Email *

Phone

The legal fund makes it possible for Hold Them Responsible to challenge those that mistreat, abuse and assault individuals expressing their legal right to express their support for any political candidate. We appreciate your support.

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