CLAIM FORM

Send completed form/letter to: Lisa C. Lambert, City Clerk

P. O. Box 1827
Mobile, AL 36633-1827
251-208-7576 (fax)
cityclerk@cityofmobile.org
251-208-7411 (phone)
Christine Dallas/The Estate of Jawan Lee McGee Dallas
Name of Claimant: ____________________________________________________________________
4751 Best Road Suite 490
Atlanta, Georgia 30337
Mailing Address: ____________________________________________________________________

Phone Number: (678) 664-8529

(H)_____________________________ (C)________________________________

July 2, 2023
Date of Accident/Property damage: _______________________________________________________

Location of accident/property damage: Carroll Plantation Rd. Theodore, Alabama 36582

___________________________________________________

Police report number (if applicable): ___________________________________________________

Witness(s): name, address, phone number (if applicable) ____________________________________

_____________________________________________________________________________________
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Describe accident, injuries, and/or property damage: (attach additional sheets of paper, if necessary)
On July 2, 2023, Jawan Dallas was subjected to an unlawful seizure of his person by a member(s) of the Mobile
_____________________________________________________________________________________
Police Department. Jawan Dallas was unlawfully arrested in violation of Alabama law. Subsequently, Jawan
Dallas was subjected to an unlawful seizure by a member(s )of the Mobile Police Department. Jawan Dallas was
_____________________________________________________________________________________
struck and tased multiple times in violation of Alabama law. As a result of being tased and/or struck Jawan
Dallas died by a member(s) of the Mobile Police Department. (See Attached)
_____________________________________________________________________________________

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Attach at least two (2) estimates of repair; or attach a copy of all bills related to the claim.
NOTE: This claim will be recorded the day it is received & sent to the claims adjuster (CCMSI) for processing.

*To check the status of your claim, please call the adjuster, with Canon Cochran
Management Services Inc. (CCMSI) at (601) 608-10 .

/s/Christine Dallas 7/19/2023

__________________________________________ __________________________________
Signature of Claimant Date

**Please note there is a limit of six (6) months on filing claims for injuries/damages**
Describe accident, injuries, and/or property damage.

On July 2, 2023, Jawan Dallas, a 36-year-old black man, died after being tased
multiple times by a member(s) of the Mobile Alabama Police Department in
Theodore, Alabama. According to eyewitnesses, Mr. Dallas was brutally beating by
a member(s) of Mobile Alabama Police Department before he died. According to a
911 call on the day of the incident, a couple reported that their mobile home was
being burglarized. The 911 call prompted a rapid response by police. However,
during the same call, the caller informed dispatch that someone was only in his yard
and not a burglary that was initially reported by the caller. (See attached 911
transcript). Therefore, the caller only reported a trespass to property to the 911
dispatcher. Notably, entering a person’s property without authorization is a
misdemeanor in the state of Alabama. After responding to the scene, the responding
officers confronted Mr. Dallas and another man who were not suspected of
committing a burglary or trespass. Mr. Dallas and another man were approximately
150 yards down the street from where the alleged trespass occurred. Also, according
to the 911 caller, the person who allegedly trespassed on the 911 caller’s property,
was believed to be homeless by the 911 caller. Notably, Mr. Dallas was confronted
by the police while sitting in his fully functional vehicle and did not present to be
indigent or homeless. The responding officer(s) demanded Mr. Dallas to produce
his state issued identification card to them. However, Mr. Dallas refused to do so
because he had not committed any crime. In response to Mr. Dallas refusal to
produce his state issued identification card Mr. Dallas was detained/arrested. At
some point during Mr. Dallas’ detention/arrest, Mr. Dallas was tased several times
and brutally beaten by a member(s) of Mobile Alabama Police Department
according to eyewitnesses. Notably, the Mobile Police Department acknowledged
that Mr. Dallas was struck by an officer, drive stunned, and tased at least twice on
the night of the incident. Ironically, the 911 caller and his wife, are the eyewitnesses
to the Mr. Dallas being beating by a responding officer(s). They also confirmed that
Mr. Dallas was not the person on their property. Mr. Dallas died as a result of being
beaten and/or tased by a member(s) of the Mobile Alabama Police Department.