March, 2005 

RTP Lawsuit Plaintiffs:

Use This Form To Report Retaliation
 
 1) Use this form is to report incidents of retaliation by IRS agents
due to your status as a named Plaintiff in the Right-to-Petition lawsuit.

2) Provide a brief OVERVIEW of the retaliation.

3) We ONLY want to hear from people who are listed named as Plaintiffs
in the case AND have been injured (i.e., threats, intimidation, levies, liens, etc)
SUBSEQUENT to the filing of the of Complaints containing
the lists of named Plaintiffs (i.e., November, 2004),
AND
who believe their injuries were caused by government officials solely because
such Plaintiffs publicly declared themselves as Plaintiffs in the Right-to-Petition lawsuit.

4)  You will be contacted later IF we need
     your sworn affidavit and/or your evidence.

 5) NOTE: When filling out the form, do NOT hit the enter button until ALL
     the required fields are filled out!

NOTICE:  Your responses are --NOT-- privileged attorney-client communications
 and may be directly disclosed in court filings .
Be sure to include valid contact phone number
& e-mail address so we can contact you.

If you receive a response message after submitting the form,
your submission has been recorded in our database.

Check
(1) One Box:		   I have seen my name listed in the
       lawsuit Complaint filed with the Court.
       
  RIGHT-Click here to download a copy of the pages listing the Plaintiffs
  extracted from the Second Amended Complaint (November, 2004)
  (175 KB in Adobe .pdf format)
 
  I have previously APPLIED to become a Plaintiff, and have
       sent in an affidavit, BUT I still do NOT see my name in
       the Complaint yet.
       (Note: Many applications submitted since Nov. 2004 are still awaiting submittal to the Court
             pending the District Court's decision on the Motion to Dismiss.)
 
LAST name  
FIRST name  
Middle/Initial  
Suffix       (Jr., Dr., etc.)
Address-1  
Address-2  
City  
State     (2 character abbreviation)
ZIP (first 5)  
E-mail  
Phone  
   
General Form
 of Retaliation

 
General Form
 of Retaliatory Contact
 
Name/Title/Badge#
of IRS Agent Involved
 
IRS Agent's 
Office Location
City-State (only)
 		 City    State 
Approx. Date of Retaliation
 
  Example: 2005-Jan-10
Have Evidence?
Please Specify

Briefly Describe
the Retaliation

  BRIEFLY describe:
  1) The relevant facts (who, what, where, etc.)
      AND
  2) Explain why you believe the retaliation was a direct result of your becoming
      a Plaintiff,
      AND,
  3) Describe your injuries

 Please, 200 Words or LESS   


    I am willing to
provide a sworn affidavit as to these facts and copies of my
evidence, if any.
 

    Check one:

   YES   

   NO   

Please re-check your entries and then hit  

THANKS!

Again -- we will contact you if we need additional information.....
PLEASE -- do NOT re-submit submissions!