May we use your information for legislative purposes? Yes-Use My Information No - DO NOT use my information ~ Please Select ~

What type of incident are you reporting on this form? Traffic Stop Harassment Profiling Traffic Stop and Harassment or Profiling Other ~ Please Select ~

Harassment or Profiling Incident

Motorcycle profiling is defined as: When law enforcement officers single out people who ride motorcycles or wear biker garb by stopping, questioning, searching or arresting them without legal grounds.

When did this incident occur? January February March April May June July August September October November December ~ Month ~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ~ Day ~ 2015 2016 2017 2018 ~ Year ~ Time: PM AM ~ Please Select ~

Where did this incident occur?

What Happened?

Traffic Stop Information

When were you stopped? January February March April May June July August September October November December ~ Month ~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ~ Day ~ 2015 2016 2017 2018 ~ Year ~ Time: PM AM ~ Please Select ~   

Location where you were stopped?

Officers name: ID#: Police Jurisdiction:

Primary reason for stop: Helmet/Other, please specify:

Was a citation issued? Yes No ~ Please Select ~

Citation#: 1st appearance date: Time: PM AM ~ Please Select ~

Court Location - City/County:

List any other charges issued at the same time:

If there were any criminal charges (not infractions) issued, specify:

If you were charged with a crime you should IMMEDIATELY obtain LEGAL ADVICE!

Did the officer follow normal traffic laws in making the stop? Yes No I think so. I do not know. ~ Please Select ~

If you do not think the officer followed normal traffic laws please explain:

Did officer treat you fairly and respectfully? Yes No ~ Please Select ~

If no, please explain:

Was your helmet confiscated/taken? Yes No ~ Please Select ~

If yes, please explain:

Were you given an explanation on legal or illegal helmets? Yes No ~ Please Select ~

If yes, was the explanation written, verbal or both? Written Verbal Both ~ Please Select ~

If verbal, describe the explanation:

What Happened In Court?

Have you gone to court? Yes No ~ Please Select ~
If you HAVE NOT GONE TO COURT, when is the court date?

If you HAVE GONE TO COURT, how did you plead? Guilty Not Guilty ~ Please Select ~

If you pled GUILTY, what was the fine?

If you pled NOT GUILTY, have you gone to trial? Yes No ~ Please Select ~

If you pled NOT GUILTY AND HAVE NOT GONE TO TRIAL , when is your court date?

If you HAVE GONE TO TRIAL , what was the verdict? Guilty Not Guilty ~ Please Select ~

If you were FOUND GUILTY, what was the sentence?

How much were you fined?

Assessment: State:      County:      City:

Work hours lost:      Lost wages:

Briefly describe the evidence you presented at your trial:

Describe the Helmet You Were Wearing

Brand: Model:

When you bought the helmet did it have a DOT sticker on the outside? Yes No ~ Please Select ~

Was the label permanenetly fastened inside the helmet? Yes No ~ Please Select ~

Was the helmet modified? Yes No ~ Please Select ~

If it was modified please describe the modifications:

Additional Information, comments or questions: