Sample Declaration (28 U.S.C. § 1746)
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section1983.org sample document. Educational template, not legal advice, not verified for your court. Replace every bracketed item. Check your district's local rules and your judge's standing orders before filing. Downloaded from https://www.section1983.org/downloads/

UNITED STATES DISTRICT COURT
FOR THE [DISTRICT]

[YOUR NAME],                                   )
                                               )
       Plaintiff,                              )
                                               )
v.                                             )      Civil Action No. __________
                                               )
OFFICER JANE MARTINEZ, et al.,                 )
                                               )
       Defendants.                             )

DECLARATION OF [YOUR NAME]

I, [Your Name], declare under penalty of perjury under 28 U.S.C. Section 1746 that the
following is true and correct based on my personal knowledge:

1. I am the Plaintiff in this action.

2. On March 3, 2025, at approximately 8:15 p.m., I was standing on the public sidewalk near
   400 Main Street in Exampleville, holding my cell phone and recording police activity.

3. I remained several feet away from the officers and did not cross any police tape, touch
   any officer, or interfere with their activities.

4. I heard Officer Jane Martinez say words to the effect of, "Stop recording and move on."

5. I responded that I was on a public sidewalk and had the right to record.

6. Within seconds, Officer Martinez grabbed my left arm, pulled it behind my back, and
   placed me in handcuffs.

7. I did not swing at, threaten, push, or physically resist Officer Martinez or any other
   officer.

8. Officer David Lewis then assisted Officer Martinez in escorting me to a patrol vehicle.

9. I asked what I was being arrested for. Officer Martinez stated, "Disorderly conduct."

10. Before I was handcuffed, no officer told me that I was blocking traffic, creating a
    disturbance, or committing any crime.

11. I was transported to the Exampleville jail and detained for approximately six hours.

12. I was released without being formally charged.

13. Attached as Exhibit 1 is a true and correct copy of a screenshot from the video I
    recorded that night.

14. Attached as Exhibit 2 is a true and correct copy of the release paperwork I received
    from the jail.

15. Attached as Exhibit 3 is a true and correct copy of my records request response showing
    that body-camera footage exists for the incident.

I declare under penalty of perjury that the foregoing is true and correct.

Executed on [date], in [city, state].

[Signature]
[Printed Name]