Wufoo

Name * First Last
77) Were statements made by the January 6th Select Committee used against you? (Yes/No)
Yes No
a) If yes, explain how the committee’s narrative influenced your case.
78) Did the committee release edited or misleading footage of you? (Yes/No)
Yes No
79) Did media outlets misrepresent your actions or falsely accuse you? (Yes/No)
Yes No
a) If yes, name the outlets and describe the damage caused.
80) Were you defamed or labeled as an insurrectionist or domestic terrorist? (Yes/No)
Yes No
81) Did the public narrative taint the jury pool in your case? (Yes/No)
Yes No
82) Did social media platforms ban, censor, or suppress content related to your case?
(Yes/No)
Yes No
83) Were you harassed, doxed, or threatened as a result of media coverage? (Yes/No)(Yes/No)
Yes No
84) Upload all media articles, videos, and committee reports relevant to your case.

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85) Final Supporting Evidence
86) Upload Any Additional Statements or Witness Testimony:

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87) Upload Any Other Documents You Believe an Attorney Should See:

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88) Provide Any Additional Information You Feel is Relevant to Your Case:
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