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January 30, 2020

Chief Frank Talbot, DOJ-MDFL


U.S. Department of Justice Assistant U.S. Attorney
950 Pennsylvania Avenue, N.W. U.S. Attorney's Office
Civil Rights Division 300 N. Hogan Street, Suite 700
Disability Rights Section – NYA Jacksonville, FL 32202
Washington, D.C. 20530 frank.m.talbot@usdoj.gov
ADA.complaint@usdoj.gov USAFLM.Civil.Rights@usdoj.gov

Dr. Scott A. Rivkees, Florida Surgeon General FBI Tampa Division


Florida Department of Health Michael F. McPherson
4052 Bald Cypress Way, Bin C75 Special Agent in Charge
Tallahassee, Florida 32399-3260 tampa.division@ic.fbi.gov
850-245-4339
MQA.ConsumerServices@flhealth.gov FBI Jacksonville Division
Rachel Rojas
Special Agent in Charge
jacksonville@ic.fbi.gov
RE: Civil Rights and ADA Disability Complaint

To Law Enforcement, and Dr. Rivkees, Florida Surgeon General:

My name is Neil J. Gillespie, age 63. I have type 2 adult onset diabetes. This is my Civil Rights
and ADA Disability complaint for Walmart and the Marion County Sheriff’s Office. Walmart’s
ReliOn Novolin Human Insulin is literally my lifeline. Without it, I will become sick and die.

Walmart’s insulin is sold over the counter without a prescription for $24.88 per vial. I inject
insulin with a ReliOn Insulin Syringe, 1ml, 31 gauge, 8mm length, 100 in a box for $12.58.
I am a cash customer for insulin. I have Medicare but not Part D for prescription coverage.

On December 31, 2019 I planned to buy 1 vial of Novolin N type insulin from the Walmart
Neighborhood Market, 7855 SW State Rd 200, Ocala, FL 34476. I asked what time the
pharmacy closed, since it was New Years Eve, and I had to go get money for the purchase.
“Nori” at the store’s service center said the pharmacy was open to 9:00 PM, regular hours.
When I returned at 7:00 PM or so with money to buy insulin, the pharmacy was closed.

However the pharmacist and pharmacy employees were still in the pharmacy after it closed, but I
was not able to buy insulin. I contacted store manager Josh Mcadams, who essentially said tough
luck. When I asked for the name of the pharmacist, Mr. Mcadams refused to provide the name as
required by Florida Administrative Code (FAC) RULE: 64B16-27.100 Proof of Licensure;
Display of License; Pharmacist, Registered Pharmacy Intern and Registered Pharmacy
Technician Identification. Mr. Mcadams then threatened to call the Marion County Sheriff’s
Office unless I left the store without the identity of the pharmacist. The pharmacist, an older
white woman still in the pharmacy, also refused to identify herself when I asked. I left the store
thinking the early pharmacy closure without a sign, and a rude pharmacist, was an aberration.
RE: Civil Rights and ADA Disability Complaint January 30, 2020

FAC RULE: 64B16-27.100 Proof of Licensure; Display of License; Pharmacist, Registered


Pharmacy Intern and Registered Pharmacy Technician Identification, states:

“(1) Proof of licensure. Every pharmacist, pharmacy intern, and registered pharmacy
technician must maintain proof of current licensure such that it is readily retrievable upon
request by any representative of the Department or the Board or any member of the
public. The pharmacy may display the license or registration of each pharmacy employee
or alternatively, may display a notice easily accessible to the public that the license or
registration of each employee is available for viewing upon request.”

“(2) Identification. Every Pharmacist, Pharmacy Intern, or Registered Pharmacy


Technician must be identified by means such as a clearly visible identification badge or
monogrammed smock showing their name and if they are a pharmacist, pharmacy intern,
or registered pharmacy technician. In addition, all registered pharmacy technicians shall
state their names and verbally identify themselves as registered pharmacy technicians in
the context of telephone or other forms of communication.”

By closing early, the pharmacy was in violation of Florida Administrative Code Rule 64B16-
28.1081, Regulation of Daily Operating Hours. The relevant portion of the Rules states:

FAC Rule 64B16-28.1081 Regulation of Daily Operating Hours.

“Any person who receives a community pharmacy permit pursuant to Section 465.018,
F.S., and commences to operate such an establishment shall keep the prescription
department of the establishment open for a minimum of forty (40) hours per week. The
Board hereby approves exceptions to the requirements noted above and permits closing
of the prescription department for the following holidays: New Year’s Day, Memorial
Day, Fourth of July (Independence Day), Labor Day, Veterans’ Day, Thanksgiving,
Christmas and any bona fide religious holiday provided that notice of such closing is
given in a sign as set forth herein. A sign in block letters not less than one inch in height
stating the hours the prescription department is open each day shall be displayed either at
the main entrance of the establishment or at or near the place where prescriptions are
dispensed in a prominent place that is in clear and unobstructed view...”

The pharmacy could lawfully close on New Year’s Day, but not early on New Year’s Eve, and
not without posting the required sign giving notice of the closure. “A sign in block letters not
less than one inch in height stating the hours the prescription department is open each day shall
be displayed either at the main entrance of the establishment or at or near the place where
prescriptions are dispensed in a prominent place that is in clear and unobstructed view...”

Later I was informed about a small sign was affixed flat to the pharmacy counter, but it was not
in a prominent place that had a clear and unobstructed view. The sign was blocked by anyone
standing at the counter.

The pharmacy at the Walmart Supercenter, 9570 SW State Rd 200, Ocala, FL 34481, also closed
early on New Years Eve, without a sign, in violation of FAC Rule 64B16-28.1081.

2
RE: Civil Rights and ADA Disability Complaint January 30, 2020

Photo by Neil J. Gillespie

As noted, I have type 2 adult onset diabetes. Walmart’s ReliOn Novolin Human Insulin is
literally my lifeline. Currently I use eight (8) vials of Novolin N type (long lasting) insulin per
month, and one (1) vial of Novolin R type (fast acting). Nine (9) total vials of insulin a month
costs $233.92 (9 X $24.88), plus $12.58 for a box of 100 1ml syringes, $18.95 for a box of 100
30/100 cc syringes (Publix) for use with R type insulin, several boxes of prep pads @ 2.00 each,
and test strips for my glucose meter. The total cost is about $280 a month, thanks to Walmart’s
ReliOn Novolin Insulin at $24.88 per vial. Similar insulin bought elsewhere, such as Publix, is
typically $150 per vial. I save about $1,116.00 a month with Walmart insulin ($233.92) over
Publix ($1,350). For me, there is no viable alternative to buying insulin at Walmart.

On January 1, 2020, I bought one (1) vial of ReliOn Novolin N type for $24.88, which was all I
could afford, from the Supercenter Pharmacy. The receipt for $24.88 appears at Exhibit 1.

On January 3, 2020, after getting paid, I went back to the Supercenter Pharmacy to buy more
insulin. Unfortunately, Walmart limits sales to four (4) vials of insulin a day per customer. My
receipt for $99.52 (4 vials) appears at Exhibit 2. The four (4) vial limit means a minimum of
three trips a month to the Walmart Pharmacy to get a month’s supply of nine (9) vials.

Although Walmart’s ReliOn Novolin Insulin is sold without a prescription, over the counter
(OTC), Walmart keeps its insulin in a refrigerator in the pharmacy. In order to buy Walmart’s
OTC insulin, a customer must wait in the same line as prescription customers at the store. That is
true at the Walmart Supercenter, and at the Walmart Neighborhood Market.

3
RE: Civil Rights and ADA Disability Complaint January 30, 2020

I usually shop for insulin at the Supercenter Pharmacy because the Supercenter is closer to my
home than the Neighborhood Market Pharmacy. On January 3, 2020, I made two trips to the
Supercenter Pharmacy to by insulin. My first trip was unsuccessful. The prescription waiting line
is standing-only, and the line was too long, and the service too slow, for me to stand. Usually
there is only one employee waiting on customers in the pharmacy. The line often backs up when
there are more customers than can be served by a single employee. There is no place for a
pharmacy customer to sit without loosing their place in line. So I left the Supercenter Pharmacy
without buying insulin, but I planned to return later in the day, hoping for a shorter line.

My second trip to the Supercenter Pharmacy on January 3, 2020 was around 7:00 PM. Again, the
prescription waiting line was backed-up. When it was my turn, I asked to purchase four (4) vials
of Novolin N type insulin, and one (1) vial of Novolin R type insulin. The pharmacy employee
refused, citing Walmart’s four (4) vial limit per customer per day. So I bought four (4) vials of
Novolin N type insulin. (Exhibit 2). Then I tried to buy a box of 100 ReliOn Insulin Syringes,
1ml, 31 gauge, 5/16 syringe (8mm) length, for $12.58, UPC 6 81131 31174 8. The Supercenter
Pharmacy employee said the syringe I requested was no longer available, and offered an
unacceptable substitute, a ReliOn 1ml, 31 gauge, 15/64 syringe (6mm). I know this is false
because the Neighborhood Market Pharmacy stocks ReliOn Insulin Syringes, 1ml, 31 gauge,
5/16 syringe (8mm) length, a box of 100. (Exhibit 3). For some reason the Supercenter Pharmacy
does not stock the syringe I need, then falsely says it is not available. This is an ongoing issue for
the past two years or so. To get the syringe I need requires a longer drive to the Neighborhood
Market Pharmacy. I tried to raise this issue with the Supercenter pharmacist on duty, but was not
able to speak with her, or even know her name as required by FAC RULE: 64B16-27.100.

The Supercenter Pharmacy has 5 customer service windows in a row along its counter:

Drop Off customer service window


Pickup customer service window
Pickup customer service window
Pickup customer service window
Consultation customer service window

The Supercenter Pharmacist on duty January 3, 2020 was a middle-age, white female, with
brown hair. The Supercenter Pharmacy does not comply with FAC RULE: 64B16-27.100. As I
recall, none of the pharmacy employees were properly identified. The Supercenter Pharmacy
claims to display the license or registration of each pharmacy employee, but in a room not open
to the public. The licenses or registrations appear to be posted on a wall, but the wall is in a room
closed to the public, and is only viewable from a distance through the Drop Off customer service
window. The viewing distance is so great that I could not read what was written on the alleged
licenses or registrations, so I do not know for certain what was actually displayed.

As I was attempting to identify the Supercenter Pharmacist on duty January 3, 2020, I was
approached by Renee Row, Walmart’s asset protection manager, and an unnamed white male
with tattoos. Renee Row refused to identify the pharmacist on duty as required by FAC RULE:
64B16-27.100. Ms. Row told me Walmart’s insulin was a “controlled substance”; it is not a
controlled substance. It soon became clear Ms. Row was ignorant about pharmacy matters.

4
RE: Civil Rights and ADA Disability Complaint January 30, 2020

Ms. Row did not comply with FAC RULE: 64B16-27.100. Instead, Ms. Row called the Marion
County Sheriff’s Office (MCSO) to have me removed from the store. I also called the MCSO.

Two MCSO deputies responded as shown on the attached Incident Detail Report, Incident
number: 2001030711. (Exhibit 4). The report shows the MCSO personnel assigned:

Unit Name
6303 Bloom, John (6303P)
5425 Austin, Nicholas (5425P)

Deputy Bloom and Deputy Austin sided with Renee Row and Walmart, and refused to follow the
law established by FAC RULE: 64B16-27.100. Deputy Austin told me Walmart is a big
company and won’t do anything illegal. Deputy Austin is wrong: The Walmart Pharmacy is
required to display the license or registration of each pharmacy employee or alternatively, may
display a notice easily accessible to the public that the license or registration of each employee is
available for viewing upon request. Austin also said lying to law enforcement is not a crime.

Later on January 3, 2020, at 9:15 PM or so, I called back the MCSO with information about FAC
RULE: 64B16-27.100. A lady dispatcher said to expect call from Sergeant Blackurn or Sergeant
Levy, but no one called.

On January 26, 2020, I returned to the Supercenter Pharmacy to buy two (2) vials of ReliOn
Novolin N type. My receipt for $49.76 appears at Exhibit 5.

While at the Supercenter Pharmacy I noticed the Drop Off customer service window was shut,
thereby completely blocking the display of license or registration of each pharmacy employee.
The same unidentified pharmacist was on duty, so I handed her a copy of FAC RULE: 64B16-
27.100 when she was at the counter. (Exhibit 6). She read the rule without comment, but she
immediately sent another employee to raise the Drop Off customer service window that was
shut. Still, the display of license or registration of each pharmacy employee was unreadable.

• Attached are four (4) U.S. Department of Justice Civil Rights Complaint Forms, for:

Josh Mcadams, Store Manager, Walmart Neighborhood Market


Renee Row, Walmart Supercenter’s asset protection manager
MCSO Deputy John Bloom (6303P)
MCSO Deputy Nicholas Austin (5425P)

• I request the Department of Justice investigate the high price of insulin everywhere but at
Walmart Pharmacies, i.e. ReliOn Novolin Human Insulin @ $24.88 a vial vs. $150 or so for
a vial for other U-100 Insulin types.
• Disability accommodation at Walmart’s pharmacies to include selling OTC insulin at a
separate customer service window from prescription medication.
• Disability accommodation at Walmart’s pharmacies for seating that preserves place in line.
• Disability accommodation at Walmart’s pharmacies to stock popular size syringes.

5
RE: Civil Rights and ADA Disability Complaint January 30, 2020

• Disability accommodation at Walmart’s pharmacies to eliminate the four (4) vial limit per
person per day, and sell enough insulin to one person at one time for one month’s use.

• Request the Florida Department of Health enforce FAC RULE: 64B16-27.100 Proof of
Licensure; Display of License; Pharmacist, Registered Pharmacy Intern and Registered
Pharmacy Technician Identification.
• Request the Florida Department of Health enforce FAC RULE: 64B16-28.1081, Regulation
of Daily Operating Hours.

• Request the MCSO improve training for its deputies, i.e. Might is not always right.

So far this month I purchased $174.16 worth of insulin from Walmart’s Pharmacy:

2020, 01-01-20, ReliOn Novolin N, one (1) $24.88


2020, 01-03-20, ReliOn Novolin N, four (4) $99.52
2020, 01-26-20, ReliOn Novolin N, two (2) $49.76

Currently I am out of Novolin R type, and need one more Novolin N type to reach my next
payday, Monday February 3, 2020.

Sincerely,
/s/
Neil J. Gillespie
8092 SW 115th Loop
Ocala, Florida 34481
Tel. 352-854-7807
Email: neilgillespie@mfi.net

Cc: Bradley E King Cc: Timothy T. McCourt, General Counsel


State Attorney's Office, Fifth Circuit Marion County Sheriff’s Office
110 NW 1st Ave Ste 5000 Florida Bar No. 44604
Ocala, FL 34475-6614 PO Box 1987, Ocala, FL 34478-1987
Office: 352-671-5914 Tel. (352) 369-6758
bking@sao5.org Tmccourt@marionso.com

Cc: Karen Roberts Cc: Todd Maufroy, Store Manager


Executive Vice President and General Counsel Walmart Supercenter
Walmart Inc. 9570 SW State Rd 200
702 SW 8th Street Ocala, FL 34481, (352) 291-7512
Bentonville, AR 72716-8611
(479) 273-4000 Cc: Josh Mcadams, Store Manager
https://corporate.walmart.com/leadership/karen-roberts Walmart Neighborhood Market
https://corporate.walmart.com/our-story/leadership 7855 SW State Rd 200
https://pview.findlaw.com/view/3377579_1 Ocala, FL 34476, (352) 512-6628

6
See back of receipt for your chance
to win $1000 10 1:7P73SH1UNTJH

Walmart ~:~.
352-291-7512 Hgr:TODD HAUFROV
9570 SW HIGHWAV 200
OCALA FL 34481
sr. 05326 OPI 003490 TEl 81 rRt 010~J
DIABETES 030169183402H 24.88 H
SUBTOTAL 24.88
TOTAL 24.88
CASH TEND 25.00
CHANIE DUE 0.12
I ITEMS SOLD 1
rei 0421 2366 6475 6721 4310

II1111111111111111111111111111111111111111111111111111I1III11111111111111111I1111111111111
Save time with Express lanes
When YOU use the W.lmlrt 8PP!
01/01/20 17:01:37
Scan with Walmert 8PP to slve receipts

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1
See back of receipt for your chance
to "in $1000 ID 1:1P14021UNTN3

Walmart ~:~.
352-291-1512 Mgr:TODD HAUFROY
9510 SW HIGHWAV 200
OCALA Fl 34481
sri 05326 OPI 003498 TEl 81 TRI 0,165
DIABETES 030169183402H 24.88 N
DIABETES 030169183402H 24.88 N
OIABETES 030169183402H 24.88 N
DIABETES 030169183402H 24.88 N
SUBTOTAL 99.52
TOTAL 99.52
DEBIT TEND 99.52
CHAN8E DUE 0.00
EFT DEBIT PAY FROH PRIMARY
99.52 TOTAL PURCHASE
US DEBIT
REF' 000400519544
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**** **** 6831 I 0
NETWORK ID. 0056 APPR CODE 961149
US DEBIT
AID A0000000980840
Te OD366CAC136CA90A
*Pin Uerifted
TERMINAL' 5C011054
01/03/20 19:12:06
• ITEHS SOLD 4
TCI 4837 1259 5912 5174 9436

1 1 1 1 1 1 1 1 I1 1 1 1 1~ 11111 ~I I I I I I I I I I I I I I I I I I I I I I I I I I I I

2
81131-0311-74

Reli On®

Insulin Syringes

100 Sterile Single Use Syringes in 10 Packs

CAPACITY GAUGE LENGTH

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3
1/6/2020 Inform Browser : 5.821.55.3 - Reports - Incident Report

Incident Detail Report


Data Source: Data Warehouse
Incident Status: Closed
Incident number: 2001030711
Case Numbers:
Incident Date: 01/03/2020 19:23:57
Report Generated: 01/06/2020 15:54:12

Incident Information
Incident Type: One Unit Response Alarm Level:
Priority: Priority 2 Problem: S22V - Verbal Disturbance
Determinant: 113D02 Agency: Marion Co SO
Base Response#: 01032020-0000187 Jurisdiction: MCSO
Confirmation#: 01032020-0001959 Division: South West
Taken By: Davis, KarDasaty Battalion: 42
Response Area: 42 Response Plan: One Unit
Disposition: 1806M-DIST,NON DOMESTIC,1806M- Command Ch:
DIST,NON DOMESTIC
Cancel Reason: Primary TAC: Law Ch 3
Incident Status: Closed Secondary TAC:
Certification: SO Operations Delay Reason (if any):
Longitude: 82278252 Latitude: 29058549

Incident Location
Location Name: Walmart (9570 SW HWY 200) County: MARION
Address: 9570 Sw Hwy 200 Location Type: Stores/Business
Apartment: Cross Street: SW 95TH CIR/SW 114TH ST
Building: Map Reference: pg156/2A
City, State, Zip: OCALA FL 34481

Supplemental Information - Person


PERSON 1
Race: WHITE Gender: MALE
Age: 60 - 70 Weight: 250
Hair: GRAY Build: Height: 5'6,
Comments: Clothes: plaid shirt, pants

Call Receipt
Caller Name: row, renee - assest protection manager
Method Received: NON-EMERGENCY Call Back Phone: 352-678-9681
Caller Type: 1st Party Caller Caller Location:

Time Stamps Elapsed Times


Description Date Time User Description Time
Phone Pickup 01/03/2020 19:22:57
1st Key Stroke 01/03/2020 19:22:57 Received to In Queue 00:00:00
In Waiting Queue 01/03/2020 19:23:57 Call Taking 00:08:57
Call Taking Complete 01/03/2020 19:32:54 Davis, KarDasaty In Queue to 1st Assign 00:04:08.8
1st Unit Assigned 01/03/2020 19:28:05 Call Received to 1st Assign 00:05:08.8
1st Unit Enroute 01/03/2020 19:28:05 Assigned to 1st Enroute -00:00:00.
1st Unit Arrived 01/03/2020 19:32:47 Enroute to 1st Arrived 00:04:41.8
Closed 01/03/2020 19:47:40 Gann, Troy N Incident Duration 00:24:43

Resources Assigned
Primary Delay Odm. Odm.
Unit Flag Assigned Disposition Enroute Staged Arrived At Patient Avail Complete Enroute Arrived Cancel Reason
6303 Y 19:28:05 19:28:05 19:32:47 19:47:40
5425 N 19:29:24 1806M- 19:29:24 19:38:05 19:47:40
DIST,NON
DOMESTIC

Personnel Assigned
Unit Name
6303 Bloom, John (6303P)
5425 Austin, Nicholas (5425P)

Pre-Scheduled Information
No Pre-Scheduled Information

Transports
No Transports Information

Transport Legs
No Transports Information

Comments
Date Time User Type Conf. Comments
01/03/2020 19:23:49 KD Response [1] adc customer in pharmacy being s22v with pharmacist and rp
01/03/2020 19:23:54 KD Response [2] refusing to leave loc
[3] [ProQA Dispatch]
Dispatch Level: 113D02
01/03/2020 19:24:37 KD Response Response Text: Delta
Problem Description: adv customer s22v

01/03/2020 19:24:37 KD Response


Chief Complaint: , CCText: Disturbance / Nuisance
[4] [ProQA: Key Questions]
> No known weapons were involved.
> The victim caller is on scene.
4
> One person is reportedly involved.
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> This incident just happened (minutes ago): 10
> This incident involves a verbal DISTURBANCE.
[5] [ProQA Person Information]
01/03/2020 19:25:42 KD Response Person 1 Description : Suspect, Race : WHITE, Sex : MALE, Clothing : plaid shirt, pants,
Age : 60-70, Height : 5'6, Weight : 250, Hair : GRAY
01/03/2020 19:25:59 AJF Response [6] Duplicate call appended to incident at 19:25:59
[7] [ProQA: Key Questions]
> No known weapons were involved.
> The victim caller is on scene.
> One person is reportedly involved.
> This incident just happened (minutes ago): 10
01/03/2020 19:26:11 KD Response > This incident involves a verbal DISTURBANCE.
> The suspect/person is on scene: sitting in the pickup area inside loc
> The suspect's description is:
> The suspect's vehicle description is not known.
> Alcohol or drugs are not involved.
> No one needs medical attention.
01/03/2020 19:26:37 AJF Response [8] ll with neil gillespie / 352-208-0968 / adv having issues getting his meds
01/03/2020 19:27:43 AJF Response [9] rp adv that he is sitting near the phatmacy entrance
01/03/2020 19:32:51 KD Response [10] >>>CALL TAKING COMPLETE<<<
[11] rp is upset that the pharmacy does not have disablity accomodations for waiting for
01/03/2020 19:34:42 AJF Response his meds / upset that the particular syringe that he likes to use is not avail / upet that he
was not provided the pharmacist name
[12] 6303 - 22V OVER AND SEPARATED OVER MEDICATIONS. SUBJECT LEFT
01/03/2020 19:46:50 6303 Response
SCENE.

Address Changes
No Address Changes

Priority Changes
No Priority Changes

Alarm Level Changes


No Alarm Level Changes

Activity Log
Date Time Radio Activity Location Log Entry User
01/03/2020 19:23:57 Incident in Waiting Queue
01/03/2020 19:23:57 Waiting Pending Incident Waiting Pending Incident Time Warning timer
Time Warning expired
01/03/2020 19:23:58 Remove Waiting Pending Removing Waiting Pending Incident Time Warning
Incident Warning timer expired
01/03/2020 19:23:58 Incident in Waiting Queue
Timer Clear
01/03/2020 19:24:37 ProQA ProQA determinant sent KD
01/03/2020 19:24:37 SOP Updated Updated SOP information is available KD
01/03/2020 19:25:42 Supplemental Information 9570 Sw Hwy 200 Supplemental Person record 491406 - Suspect was KD
added for
01/03/2020 19:25:59 Duplicate Call Warning Duplicate Call Warning - New call appended to AJF
incident
01/03/2020 19:26:00 Read Incident Incident 223 was Marked as Read. AJF
01/03/2020 19:28:05 6303 Dispatched 9570 Sw Hwy 200 [Walmart Response Number: 01032020-0000187; 6303
(9570 SW HWY 200)]
01/03/2020 19:28:05 6303 Update Sector 9570 Sw Hwy 200 From Sector CH1 to 6303
01/03/2020 19:28:05 6303 Responding 9570 Sw Hwy 200 [Walmart Responding From = HWY 200\SW 91ST AVE. 6303
(9570 SW HWY 200)]
01/03/2020 19:29:24 5425 Dispatched 9570 Sw Hwy 200 [Walmart Response Number: 01032020-0000188; TNG
(9570 SW HWY 200)]
01/03/2020 19:29:24 5425 Update Sector 9570 Sw Hwy 200 From Sector CH1 to TNG
01/03/2020 19:29:24 5425 Responding 9570 Sw Hwy 200 [Walmart Responding From = 8664 Sw 103rd Street Rd [BP TNG
(9570 SW HWY 200)] SW 103RD STREET RD].
01/03/2020 19:32:47 6303 At Scene 9570 Sw Hwy 200 [Walmart 6303
(9570 SW HWY 200)]
01/03/2020 19:32:53 UserAction User clicked Exit/Save KD
01/03/2020 19:33:13 UserAction User clicked Exit/Save TNG
01/03/2020 19:35:29 UserAction User clicked Exit/Save AJF
01/03/2020 19:37:57 Incident Late Active incident marked as late
01/03/2020 19:38:05 5425 At Scene 9570 Sw Hwy 200 [Walmart TNG
(9570 SW HWY 200)]
01/03/2020 19:38:05 Incident Late Active incident marked as late
01/03/2020 19:38:16 6303 Reset System Timer [Timer] Reset System Timer [Reset Reason] TNG
STATUS [Next Late Check Time] 01/03/2020
19:41:16
01/03/2020 19:40:24 UserAction User clicked Exit/Save TNG
01/03/2020 19:41:17 Incident Late Active incident marked as late
01/03/2020 19:45:20 6303 Reset System Timer [Timer] Reset System Timer [Reset Reason] TNG
STATUS [Next Late Check Time] 01/03/2020
19:48:20
01/03/2020 19:45:33 5425 Reset System Timer [Timer] Reset System Timer [Reset Reason] TNG
STATUS [Next Late Check Time] 01/03/2020
20:44:33
01/03/2020 19:47:40 5425 Available 9570 Sw Hwy 200 [Walmart Unit Cleared From Incident 2001030711 TNG
(9570 SW HWY 200)]
01/03/2020 19:47:40 6303 Available 9570 Sw Hwy 200 [Walmart Unit Cleared From Incident 2001030711 TNG
(9570 SW HWY 200)]
01/03/2020 19:47:40 6303 Response Closed Walmart (9570 SW HWY 200) Response Disposition: 1806M-DIST,NON TNG
DOMESTIC~^~1806M-DIST,NON DOMESTIC
01/03/2020 21:10:26 UserAction User clicked Exit/Save BP
01/03/2020 21:15:21 UserAction User clicked Exit/Save BP

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Edit Log
Date Time Field Changed From Changed To Reason Table Workstation User
01/03/2020 19:23:02 Address (Blank) 9570 sw hwy 200 New Entry Response_Master_Incident DP20180116 KD
01/03/2020 19:23:04 Jurisdiction MCFR (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:04 Division UNINCORPORATED (Response Response_Master_Incident DP20180116 KD
SOUTH FIRE Viewer)
01/03/2020 19:23:04 Battalion DISTRICT 4 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:04 Response_Area MCFD ZONE 31 OAK (Response Response_Master_Incident DP20180116 KD
RUN Viewer)
01/03/2020 19:23:04 ResponsePlanType 0 0 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:04 Primary_TAC_Channel Fire South (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:04 Address 9570 sw hwy 200 9570 SW HWY 200 Premise Response_Master_Incident DP20180116 KD
Verified
01/03/2020 19:23:04 City OCALA Updated City Response_Master_Incident DP20180116 KD
01/03/2020 19:23:04 Latitude 0 29058549 Premise Response_Master_Incident DP20180116 KD
Verified
01/03/2020 19:23:04 Longitude 0 82278252 Premise Response_Master_Incident DP20180116 KD
Verified
01/03/2020 19:23:12 Call_Back_Phone 352-678-9681 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:33 Caller_Name row, renee - assest (Response Response_Master_Incident DP20180116 KD
protection manager Viewer)
01/03/2020 19:23:56 Jurisdiction MCSO (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:56 Division South West (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:56 Battalion 42 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:56 Response_Area 42 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:56 ResponsePlanType 0 0 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:56 Primary_TAC_Channel Law Ch 3 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:57 Jurisdiction MCSO (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:57 Division South West (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:57 Battalion 42 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:57 Response_Area 42 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:57 ResponsePlanType 0 0 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:57 Primary_TAC_Channel Law Ch 3 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:23:57 Problem S22V - DISTURBANCE (Response Response_Master_Incident DP20180116 KD
- VERBAL Viewer)
01/03/2020 19:23:57 Priority_Description Priority 2 Response_Master_Incident DP20180116 KD
01/03/2020 19:23:57 Priority_Number 0 2 Response_Master_Incident DP20180116 KD
01/03/2020 19:23:57 Caller_Building NOT FOUND Response_Master_Incident DP20180116 KD
01/03/2020 19:24:22 MethodOfCallRcvd NON-EMERGENCY (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:24:27 Caller_Type 1st Party Caller (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:24:37 Certification_Level SO Operations Updated by Response_Master_Incident DP20180116 KD
ProQA
01/03/2020 19:24:37 Problem S22V - S22V - Verbal Updated by Response_Master_Incident DP20180116 KD
DISTURBANCE - Disturbance ProQA
VERBAL
01/03/2020 19:24:37 Determinant 113D02 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:24:37 EMD_Used 0 1 (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:24:37 CIS_Used 0 null (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:24:37 ProQaCaseNumberPolice 5118223 (Response Incident DP20180116 KD
Viewer)
01/03/2020 19:26:00 Read Call False True (Response Response_Master_Incident DP20160040 AJF
Viewer)
01/03/2020 19:32:53 CIS_Used 0 null (Response Response_Master_Incident DP20180116 KD
Viewer)
01/03/2020 19:32:53 ProQATerminationStateCode C (Response Incident DP20180116 KD
Viewer)

Custom Time Stamps


No Custom Time Stamps

Custom Data Fields


No Custom Data Fields

Attachments
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1/6/2020 Inform Browser : 5.821.55.3 - Reports - Incident Report

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See back of rec81Pt for your chance
to win $1000 10 1:7P76D71UP3PS

Walmart ~:~.
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DIABETES 030169183402H 24.88 N
DIABETES 030169183402H 24.88 N
SUBTOTAL 49.16
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US DEBIT **** ****
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5
1/3/2020 64B16-27.100. Proof of Licensure; Display of License; Pharmacist, Registered Pharmacy Intern and Registered Pharmacy Technician Identification, 64B16-…

Florida Administrative Code (Last Updated: December 30, 2019)


64. Department of Health
64B16. Board of Pharmacy
64B16-27. Pharmacy Practice

64B16-27.100. Proof of Licensure; Display of License; Pharmacist,


Registered Pharmacy Intern and Registered Pharmacy Technician
Identification

Effective on Tuesday, November 7, 2017

(1) Proof of licensure. Every pharmacist, pharmacy Leave a Comm


intern, and registered pharmacy technician must ent
maintain proof of current licensure such that it is readily
Rulemaking
retrievable upon request by any representative of the Events:
Department or the Board or any member of the public.
The pharmacy may display the license or registration of View Governo
each pharmacy employee or alternatively, may display a r's Review

notice easily accessible to the public that the license or


View JAPC's Re
registration of each employee is available for viewing view
upon request.
Historical
(2) Identification. Every Pharmacist, Pharmacy Intern, or Versions(4)

Registered Pharmacy Technician must be identified by Select effective date


means such as a clearly visible identification badge or to view different
version.
monogrammed smock showing their name and if they are
10/08/2015 Go
a pharmacist, pharmacy intern, or registered pharmacy
technician. In addition, all registered pharmacy
Related
technicians shall state their names and verbally identify Statutes:
themselves as registered pharmacy technicians in the
456.072, F.S.
context of telephone or other forms of communication.
465.005, F.S.
Rulemaking Authority 456.072(1)(t), 465.005, 465.0155,
465.0155, F.S.
465.022 FS. Law Implemented 456.072(1)(t), 465.022
FS. History–Amended 5-19-72, Repromulgated 12-18- 465.022, F.S.

74, Formerly 21S-1.06, 21S-1.006, Amended 7-30-91, 6


Formerly 21S-27.100, 61F10-27.100, Amended 1-30-96, Related DOAH
Cases (2)
Formerly 59X-27.100, Amended 11-18-07, 1-1-10, 10-8-
15, 11-7-17. 98-001093 Board
http://flrules.elaws.us/fac/64B16-27.100 2/3
2110 First Street, Suite 3-137 300 N. Hogan Street, Room 700
Fort Myers, Florida 33901 Jacksonville, Florida 32202
239/461-2200 904/301-6300
239/461-2219 (Fax) 904/301-6310 (Fax)

U.S. Department of Justice


35 SE 1st Avenue, Suite 300 United States Attorney 400 West Washington Street, Suite 3100
Ocala, Florida 34471 Orlando, Florida 32801
352/547-3600 Middle District of Florida 407/648-7500
352/547-3623 (Fax) 407/648-7643 (Fax)
Main Office
400 North Tampa Street, Suite 3200
Tampa, Florida 33602
813/274-6000 (Phone) - 813/274-6200 (Fax)

CIVIL RIGHTS COMPLAINT FORM


The United States Attorney’s Office, in coordination with the Civil Rights Division of the United States Department of Justice, is charged
with enforcing the federal civil rights laws throughout the Middle District of Florida. The Office therefore readily receives information that
brings to its attention possible violations of federal civil rights laws. The United States Attorney’s Office is primarily a legal office and not an
investigative agency. This Office will determine if your complaint raises a potential violation of federal civil rights laws that would be within
the jurisdiction of this Office to investigate, or should be referred to another agency for investigation or otheraction.
Person Filing Complaint Date:

Name: Neil J. Gillespie January 30, 2020


Address: 8092 SW 115th Loop
City: Ocala State: FL Zip Code: 34481
Daytime Phone#: 352-854-7807 E-mail: neilgillespie@mfi.net
Best Method & Time For Contact: Email anytime
Person/Entity You Are Filing Complaint About

Name: Josh Mcadams, Manager, Walmart Neighborhood Market


Address: 7855 SW State Rd 200
City: Ocala State: FL Zip Code: 34476
Daytime Phone#: (352) 512-6628 E-mail: unknown
Best Method & Time For Contact: unknown
Nature of alleged civil rights violation (please check area that applies to your complaint):
Abortion Clinic Access Human Trafficking
Credit/Lending Opportunities Law Enforcement Misconduct
✔ Disability Rights or Access Military/Veteran Status
Educational Opportunities Prisoner or Institutionalized Person Rights
Employment Discrimination Religious Land Use
Hate Crime Voter Rights
Housing Discrimination ✔ Other:

What do you believe was the reason for the discrimination?


✔ age, civil rights
___Disability ___National Origin ___Race ___Religion ___Sexual Orientation ___Other____________________

1
Describe the civil rights violation that you would like to bring to the attention of the U.S. Attorney’s Office. Include as much
information as possible, including the date, place, nature of incident and contact information for any witnesses (please include
copies of supporting documentation, but do not send original documents):
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________
Please see attached letter.
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

__________________________________________________________________________________Attached additional page(s) if necessary.

Are you represented by an attorney in this matter? [ Yes [ No


If yes, please provide name of attorney, address and phone number:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

Have you filed a lawsuit concerning this matter? [ Yes [ No


If yes, please provide the case name, court in which the case was brought, and the status of the case:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Have you filed a complaint about this matter with any other federal, state, or government agency?
[ Yes [ No
If yes, please list the agency, contact person, phone number and status of the complaint:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2
This Office will carefullyconsider the information you have provided us to determine whethera violation of the federal civil rights
laws may have occurred and if so, whether this Office has enforcement authority with respect to the violation. If this Office
determines that your complaint raises a potential violation of federal civil rights laws that would be within the jurisdiction of
this Office to investigate and/or that further information from you is necessary for any investigation, we will contact you.

________________________________________________________________

PLEASE UNDERSTAND THAT SUBMITTING THIS COMPLAINT FORM HAS NO EFFECT ONANYSTATUTE
OFLIMITATIONS OROTHERFILINGREQUIREMENTSTHATMIGHT APPLY TO ANY CLAIM YOU MAY HAVE.

FURTHER, BY SUBMITTING THIS CLAIM YOU HAVE NOT COMMENCED A LAWSUIT OR OTHER LEGAL
PROCEEDING, AND THIS OFFICE HAS NOT INITIATED A SUIT OR PROCEEDING ON YOUR BEHALF.

IFYOUBELIEVE YOURCIVILRIGHTS HAVE BEEN VIOLATED, AND INTEND TO BRING A LAWSUIT,


YOU SHOULD ALSO CONTACT A PRIVATE ATTORNEY.
_______________________________________________________________

E-Mail Form or PRINT and send completed complaint form and any supporting documentation to the following:

Civil Rights Complaints, Civil Division


United States Attorney’s Office
Middle District of Florida
400 N. Tampa Street, Suite 3200
Tampa, Florida 33602
Civil Rights Hotline: 813.274.6095
Email: USAFLM.Civil.Rights@usdoj.gov

3
2110 First Street, Suite 3-137 300 N. Hogan Street, Room 700
Fort Myers, Florida 33901 Jacksonville, Florida 32202
239/461-2200 904/301-6300
239/461-2219 (Fax) 904/301-6310 (Fax)

U.S. Department of Justice


35 SE 1st Avenue, Suite 300 United States Attorney 400 West Washington Street, Suite 3100
Ocala, Florida 34471 Orlando, Florida 32801
352/547-3600 Middle District of Florida 407/648-7500
352/547-3623 (Fax) 407/648-7643 (Fax)
Main Office
400 North Tampa Street, Suite 3200
Tampa, Florida 33602
813/274-6000 (Phone) - 813/274-6200 (Fax)

CIVIL RIGHTS COMPLAINT FORM


The United States Attorney’s Office, in coordination with the Civil Rights Division of the United States Department of Justice, is charged
with enforcing the federal civil rights laws throughout the Middle District of Florida. The Office therefore readily receives information that
brings to its attention possible violations of federal civil rights laws. The United States Attorney’s Office is primarily a legal office and not an
investigative agency. This Office will determine if your complaint raises a potential violation of federal civil rights laws that would be within
the jurisdiction of this Office to investigate, or should be referred to another agency for investigation or otheraction.
Person Filing Complaint Date:

Name: Neil J. Gillespie January 30, 2020


Address: 8092 SW 115th Loop
City: Ocala State: FL Zip Code: 34481
Daytime Phone#: 352-854-7807 E-mail: neilgillespie@mfi.net
Best Method & Time For Contact: Email anytime
Person/Entity You Are Filing Complaint About

Name: Renee Row, Walmart Supercenter’s asset protection manager


Address: 9570 SW State Rd 200
City: Ocala State: FL Zip Code: 34481
Daytime Phone#: (352) 291-7512 E-mail: unknown
Best Method & Time For Contact: unknown
Nature of alleged civil rights violation (please check area that applies to your complaint):
Abortion Clinic Access Human Trafficking
Credit/Lending Opportunities Law Enforcement Misconduct
✔ Disability Rights or Access Military/Veteran Status
Educational Opportunities Prisoner or Institutionalized Person Rights
Employment Discrimination Religious Land Use
Hate Crime Voter Rights
Housing Discrimination ✔ Other:

What do you believe was the reason for the discrimination?


✔ age, civil rights
___Disability ___National Origin ___Race ___Religion ___Sexual Orientation ___Other____________________

1
Describe the civil rights violation that you would like to bring to the attention of the U.S. Attorney’s Office. Include as much
information as possible, including the date, place, nature of incident and contact information for any witnesses (please include
copies of supporting documentation, but do not send original documents):
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________
Please see attached letter.
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

__________________________________________________________________________________Attached additional page(s) if necessary.

Are you represented by an attorney in this matter? [ Yes [ No


If yes, please provide name of attorney, address and phone number:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

Have you filed a lawsuit concerning this matter? [ Yes [ No


If yes, please provide the case name, court in which the case was brought, and the status of the case:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Have you filed a complaint about this matter with any other federal, state, or government agency?
[ Yes [ No
If yes, please list the agency, contact person, phone number and status of the complaint:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2
This Office will carefullyconsider the information you have provided us to determine whethera violation of the federal civil rights
laws may have occurred and if so, whether this Office has enforcement authority with respect to the violation. If this Office
determines that your complaint raises a potential violation of federal civil rights laws that would be within the jurisdiction of
this Office to investigate and/or that further information from you is necessary for any investigation, we will contact you.

________________________________________________________________

PLEASE UNDERSTAND THAT SUBMITTING THIS COMPLAINT FORM HAS NO EFFECT ONANYSTATUTE
OFLIMITATIONS OROTHERFILINGREQUIREMENTSTHATMIGHT APPLY TO ANY CLAIM YOU MAY HAVE.

FURTHER, BY SUBMITTING THIS CLAIM YOU HAVE NOT COMMENCED A LAWSUIT OR OTHER LEGAL
PROCEEDING, AND THIS OFFICE HAS NOT INITIATED A SUIT OR PROCEEDING ON YOUR BEHALF.

IFYOUBELIEVE YOURCIVILRIGHTS HAVE BEEN VIOLATED, AND INTEND TO BRING A LAWSUIT,


YOU SHOULD ALSO CONTACT A PRIVATE ATTORNEY.
_______________________________________________________________

E-Mail Form or PRINT and send completed complaint form and any supporting documentation to the following:

Civil Rights Complaints, Civil Division


United States Attorney’s Office
Middle District of Florida
400 N. Tampa Street, Suite 3200
Tampa, Florida 33602
Civil Rights Hotline: 813.274.6095
Email: USAFLM.Civil.Rights@usdoj.gov

3
2110 First Street, Suite 3-137 300 N. Hogan Street, Room 700
Fort Myers, Florida 33901 Jacksonville, Florida 32202
239/461-2200 904/301-6300
239/461-2219 (Fax) 904/301-6310 (Fax)

U.S. Department of Justice


35 SE 1st Avenue, Suite 300 United States Attorney 400 West Washington Street, Suite 3100
Ocala, Florida 34471 Orlando, Florida 32801
352/547-3600 Middle District of Florida 407/648-7500
352/547-3623 (Fax) 407/648-7643 (Fax)
Main Office
400 North Tampa Street, Suite 3200
Tampa, Florida 33602
813/274-6000 (Phone) - 813/274-6200 (Fax)

CIVIL RIGHTS COMPLAINT FORM


The United States Attorney’s Office, in coordination with the Civil Rights Division of the United States Department of Justice, is charged
with enforcing the federal civil rights laws throughout the Middle District of Florida. The Office therefore readily receives information that
brings to its attention possible violations of federal civil rights laws. The United States Attorney’s Office is primarily a legal office and not an
investigative agency. This Office will determine if your complaint raises a potential violation of federal civil rights laws that would be within
the jurisdiction of this Office to investigate, or should be referred to another agency for investigation or otheraction.
Person Filing Complaint Date:

Name: Neil J. Gillespie January 30, 2020


Address: 8092 SW 115th Loop
City: Ocala State: FL Zip Code: 34481
Daytime Phone#: 352-854-7807 E-mail: neilgillespie@mfi.net
Best Method & Time For Contact: Email anytime
Person/Entity You Are Filing Complaint About

Name: MCSO Deputy John Bloom (6303P)


Address: PO Box 1987
City: Ocala State: FL Zip Code: 34478-1987
Daytime Phone#: (352) 369-6758 E-mail: unknown
Best Method & Time For Contact: unknown
Nature of alleged civil rights violation (please check area that applies to your complaint):
Abortion Clinic Access Human Trafficking
Credit/Lending Opportunities ✔ Law Enforcement Misconduct
✔ Disability Rights or Access Military/Veteran Status
Educational Opportunities Prisoner or Institutionalized Person Rights
Employment Discrimination Religious Land Use
Hate Crime Voter Rights
Housing Discrimination ✔ Other:

What do you believe was the reason for the discrimination?


✔ age, civil rights
___Disability ___National Origin ___Race ___Religion ___Sexual Orientation ___Other____________________

1
Describe the civil rights violation that you would like to bring to the attention of the U.S. Attorney’s Office. Include as much
information as possible, including the date, place, nature of incident and contact information for any witnesses (please include
copies of supporting documentation, but do not send original documents):
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________
Please see attached letter.
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

__________________________________________________________________________________Attached additional page(s) if necessary.

Are you represented by an attorney in this matter? [ Yes [ No


If yes, please provide name of attorney, address and phone number:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

Have you filed a lawsuit concerning this matter? [ Yes [ No


If yes, please provide the case name, court in which the case was brought, and the status of the case:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Have you filed a complaint about this matter with any other federal, state, or government agency?
[ Yes [ No
If yes, please list the agency, contact person, phone number and status of the complaint:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2
This Office will carefullyconsider the information you have provided us to determine whethera violation of the federal civil rights
laws may have occurred and if so, whether this Office has enforcement authority with respect to the violation. If this Office
determines that your complaint raises a potential violation of federal civil rights laws that would be within the jurisdiction of
this Office to investigate and/or that further information from you is necessary for any investigation, we will contact you.

________________________________________________________________

PLEASE UNDERSTAND THAT SUBMITTING THIS COMPLAINT FORM HAS NO EFFECT ONANYSTATUTE
OFLIMITATIONS OROTHERFILINGREQUIREMENTSTHATMIGHT APPLY TO ANY CLAIM YOU MAY HAVE.

FURTHER, BY SUBMITTING THIS CLAIM YOU HAVE NOT COMMENCED A LAWSUIT OR OTHER LEGAL
PROCEEDING, AND THIS OFFICE HAS NOT INITIATED A SUIT OR PROCEEDING ON YOUR BEHALF.

IFYOUBELIEVE YOURCIVILRIGHTS HAVE BEEN VIOLATED, AND INTEND TO BRING A LAWSUIT,


YOU SHOULD ALSO CONTACT A PRIVATE ATTORNEY.
_______________________________________________________________

E-Mail Form or PRINT and send completed complaint form and any supporting documentation to the following:

Civil Rights Complaints, Civil Division


United States Attorney’s Office
Middle District of Florida
400 N. Tampa Street, Suite 3200
Tampa, Florida 33602
Civil Rights Hotline: 813.274.6095
Email: USAFLM.Civil.Rights@usdoj.gov

3
2110 First Street, Suite 3-137 300 N. Hogan Street, Room 700
Fort Myers, Florida 33901 Jacksonville, Florida 32202
239/461-2200 904/301-6300
239/461-2219 (Fax) 904/301-6310 (Fax)

U.S. Department of Justice


35 SE 1st Avenue, Suite 300 United States Attorney 400 West Washington Street, Suite 3100
Ocala, Florida 34471 Orlando, Florida 32801
352/547-3600 Middle District of Florida 407/648-7500
352/547-3623 (Fax) 407/648-7643 (Fax)
Main Office
400 North Tampa Street, Suite 3200
Tampa, Florida 33602
813/274-6000 (Phone) - 813/274-6200 (Fax)

CIVIL RIGHTS COMPLAINT FORM


The United States Attorney’s Office, in coordination with the Civil Rights Division of the United States Department of Justice, is charged
with enforcing the federal civil rights laws throughout the Middle District of Florida. The Office therefore readily receives information that
brings to its attention possible violations of federal civil rights laws. The United States Attorney’s Office is primarily a legal office and not an
investigative agency. This Office will determine if your complaint raises a potential violation of federal civil rights laws that would be within
the jurisdiction of this Office to investigate, or should be referred to another agency for investigation or otheraction.
Person Filing Complaint Date:

Name: Neil J. Gillespie January 30, 2020


Address: 8092 SW 115th Loop
City: Ocala State: FL Zip Code: 34481
Daytime Phone#: 352-854-7807 E-mail: neilgillespie@mfi.net
Best Method & Time For Contact: Email anytime
Person/Entity You Are Filing Complaint About

Name: MCSO Deputy Nicholas Austin (5425P)


Address: PO Box 1987
City: Ocala State: FL Zip Code: 34478-1987
Daytime Phone#: (352) 369-6758 E-mail: unknown
Best Method & Time For Contact: unknown
Nature of alleged civil rights violation (please check area that applies to your complaint):
Abortion Clinic Access Human Trafficking
Credit/Lending Opportunities ✔ Law Enforcement Misconduct
✔ Disability Rights or Access Military/Veteran Status
Educational Opportunities Prisoner or Institutionalized Person Rights
Employment Discrimination Religious Land Use
Hate Crime Voter Rights
Housing Discrimination ✔ Other:

What do you believe was the reason for the discrimination?


✔ age, civil rights
___Disability ___National Origin ___Race ___Religion ___Sexual Orientation ___Other____________________

1
Describe the civil rights violation that you would like to bring to the attention of the U.S. Attorney’s Office. Include as much
information as possible, including the date, place, nature of incident and contact information for any witnesses (please include
copies of supporting documentation, but do not send original documents):
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________
Please see attached letter.
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

__________________________________________________________________________________Attached additional page(s) if necessary.

Are you represented by an attorney in this matter? [ Yes [ No


If yes, please provide name of attorney, address and phone number:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

Have you filed a lawsuit concerning this matter? [ Yes [ No


If yes, please provide the case name, court in which the case was brought, and the status of the case:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Have you filed a complaint about this matter with any other federal, state, or government agency?
[ Yes [ No
If yes, please list the agency, contact person, phone number and status of the complaint:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2
This Office will carefullyconsider the information you have provided us to determine whethera violation of the federal civil rights
laws may have occurred and if so, whether this Office has enforcement authority with respect to the violation. If this Office
determines that your complaint raises a potential violation of federal civil rights laws that would be within the jurisdiction of
this Office to investigate and/or that further information from you is necessary for any investigation, we will contact you.

________________________________________________________________

PLEASE UNDERSTAND THAT SUBMITTING THIS COMPLAINT FORM HAS NO EFFECT ONANYSTATUTE
OFLIMITATIONS OROTHERFILINGREQUIREMENTSTHATMIGHT APPLY TO ANY CLAIM YOU MAY HAVE.

FURTHER, BY SUBMITTING THIS CLAIM YOU HAVE NOT COMMENCED A LAWSUIT OR OTHER LEGAL
PROCEEDING, AND THIS OFFICE HAS NOT INITIATED A SUIT OR PROCEEDING ON YOUR BEHALF.

IFYOUBELIEVE YOURCIVILRIGHTS HAVE BEEN VIOLATED, AND INTEND TO BRING A LAWSUIT,


YOU SHOULD ALSO CONTACT A PRIVATE ATTORNEY.
_______________________________________________________________

E-Mail Form or PRINT and send completed complaint form and any supporting documentation to the following:

Civil Rights Complaints, Civil Division


United States Attorney’s Office
Middle District of Florida
400 N. Tampa Street, Suite 3200
Tampa, Florida 33602
Civil Rights Hotline: 813.274.6095
Email: USAFLM.Civil.Rights@usdoj.gov

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