Caskey & Holzman, Attorneys at Law

Caskey & Holzman
6255 Sunset Blvd
Suite 2212
Los Angeles, CA
90028
(323) 467-2100 (ph)
(323) 461-1823 (fx)
CIVIL RIGHTS CASE QUESTIONNAIRE


1.  Name:
Contact: (Phone or Email)
Additional Contact: (optional)
 
2.  Who do you contend violated your civil rights?
Government Private Business
 
3.    Date of violation:
 
4.    Name of government agency or private business which violated your civil rights:
 
5.    Provide a brief description of why you believe your civil rights were violated: