INDEPENDENT POLICE REVIEW AUTHORITY 7 Date 0J5 A 2/0; 0762/ 0

 

 

 

 

 

 

 

 

 

 

CITY OF CHICAGO . 42/
Citizen Interview Report EOI 
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*Complainant lVictim?Witness (check one) 2? I?l/iPerion 
Name of Person Interviewed, SS#/Form of ID Race Date of B1rth

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Location of Incident Date of Incident Time of Incident
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The following 1s in essence but not verbatim a summary statement taken of the above named person relative to allegation(s) of misconduct
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After having read this summary of 51 Lpages and being provided the opportunity

riiakgany corrections, additions or deletionstrue and accurate summary of the interview I had with Investigator (IL A

 

Signature of Person Interviewed . Investigator' 5 Signature



 

Other Person Present

 

 

INDEPENDENT POLICE REVIEW AUTHORITY Date-:13 7/10 (3 /0
CITY OF CHICAGO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Citizen Lnjerview Report 
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Name of Person Interviewed SS#/Form of ID Race Date of Birth
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Location of Incident 1 Date of Incident Time of Incident
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Location of Interview Time of Interview
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The following is in essence but not verbatim a summary statement taken of the above named person relative to allegation(s) of misconduct
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