Privacy & Surveillance Declaration

Provide facts tied to a specific system, search, alert, agency, company, contract, disclosure, or injury. Separate what you personally observed from what you suspect or learned from others.

Protect sensitive information

Do not submit Social Security numbers, account credentials, medical records, privileged communications, confidential informant information, sealed records, trade secrets, or unlawfully obtained material. Preserve original documents, screenshots, videos, metadata, public-record responses, and correspondence. This form does not create an attorney-client relationship or pause any legal deadline.

Your information

Full name *

Email address *

Phone number

City, county, and state *

Your role or relationship *

What kind of submission is this? *

System, agency, and company information

Government agency, business, school, landlord, employer, or organization involved *

Technology vendor or data provider

Surveillance system or data source *

Automated license plate reader (ALPR)Facial recognition or biometric identificationPolice, municipal, neighborhood, or private camera networkDrone or aerial surveillanceCellphone, advertising, or commercial location dataConnected vehicle, telematics, toll, parking, or mobility dataRetail, landlord, employer, school, or workplace surveillanceData-fusion, watchlist, predictive-policing, or intelligence platformUnknown or other

Camera, system, incident, or agency location *

First known incident or discovery date

Permissions, attestation, and signature

United for Accountability may quote or summarize my declaration publicly after removing direct contact information and reviewing it for safety and accuracy.United for Accountability or a reviewing attorney may contact me for clarification.I declare that the information is true and accurate to the best of my personal knowledge, and I have identified material based on belief, reports, or public records rather than firsthand observation. *I consent to the use of this declaration for investigation, legal review, public-interest research, evidence preservation, and potential litigation. *

Type your full name as your signature *

Your information

System, agency, and company information

Harm, government involvement, and evidence

Permissions, attestation, and signature