Form Octf001 - Complaint Form - State Of New York Department Of Law Office Of The Attorney General Eric T. Schneiderman

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OFFICE OF THE ATTORNEY GENERAL ERIC T. SCHNEIDERMAN
STATE OF NEW YORK DEPARTMENT OF LAW
COMPLAINT FORM
ORGANIZED CRIME TASK FORCE
44 South Broadway
WHITE PLAINS, NY 10601
(914) 422-8700
1.
PLEASE TYPE OR PRINT CLEARLY IN DARK INK.
2.
YOU MUST COMPLETE THE ENTIRE FORM. INCOMPLETE OR UNCLEAR FORMS WILL BE RETURNED TO YOU.
3.
MAKE SURE YOU ENCLOSE COPIES OF IMPORTANT PAPERS CONCERNING YOUR COMPLAINT.
COMPLAINANT
Your Name:
Home Tel.:
Street Address:
Business Tel.:
City/Town:
State:
Zip:
County:
COMPLAINT
Firm or Individual about whom you are complaining: :
Street Address:
Tel.:
City/Town:
State:
Zip:
County:
Has this matter been submitted to another agency or attorney? [ ] Yes
[ ] No
If yes, please provide name and address:
Is court action pending? [ ] Yes
[ ] No
If yes, please indicate where:
PLEASE BRIEFLY DESCRIBE YOUR COMPLAINT BELOW
(use the back of form or attach additional documentation if necessary)
OCTF001 - (rev. 3/14)

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