Form L-3016 - Bingo Complaint Form
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1STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
L-3016
(Rev. 5/19/09)
BINGO COMPLAINT FORM
4437
NAME OF BINGO
NAME OF CHARITY (if known)
ADDRESS OF GAME
DATE GAME PLAYED
NATURE OF COMPLAINT
(Please give as many details and be as specific as possible including
names of employees, number of games, names of programs, etc.)
Do you wish to be contacted?
Yes
No
Your Name
Telephone Number (
)
Best Time To Call
Note: You must include your name and number if you'd like for someone to contact you. In addition, please
note the best time between 8 A.M. and 5 P.M. Monday through Friday you wish to be contacted. You may also
submit this form via fax to 803-898-5811, email to , or by calling 803-898-5393.
44371011
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