Transcription of Office of the Attorney General
1 Office of the Attorney GeneralPlease return completed consumer contact form to: Office of Attorney General Pam BondiState of FloridaPL-01, The CapitolTallahassee, Florida 32399-1050 The contact information MUST be provided as we correspond via mail. Incomplete forms cannotbe processed. PLEASE WRITE LEGIBLY. Onlybusiness per complaint Making Complaint: Name, First Name, Middle InitialMailing AddressCity, CountyState, Zip CodeComplaint is Against:Name/Firm/CompanyMailing AddressCity, CountyState, Zip CodeHome & Business Phone, including Area CodeBusiness Phone, including Area CodeEmail AddressBusiness Email or Web AddressHave you retained an Attorney ?
2 Product or Service involved:Amount Paid: $Date of Transaction:I was contacted by:TelephoneMailOtherYe sNoDid you sign a contract or other papers, estimates, invoices, or other supporting documents?Ye sNo(ATTACH COPIES. DO NOT SEND ORIGINALS.)Note:1. All documents and attachments submitted with this complaint are subject to public inspection pursuant to Chapter 119, Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of hisofficial duty shall be guilty of a misdemeanor of the second degree, punishable as provided in s.
3 , , Florida indicate if you are over the age of 60. Penalties can be enhanced for victimizing senior citizens. Over 60(PLEASE USE OTHER SIDE OF THIS FORM TO DESCRIBE YOUR COMPLAINT & ATTACH YOUR SIGNATURE)Ye sN oIf you filed complaints with any other governmental and/or consumer agencies about this matter, please list thoseagencies:Please explain your complaint. Attach additional sheets, if signature authorizes the Attorney General 's Office to take any action deemed necessary forpurposes of investigation or enforcement. I understand that the Attorney General does not representprivate citizens seeking the return of their money or other personal remedies.
4 I am filing thiscomplaint to notify your Office of the activities of this company so that it may be determined if lawenforcement or legal action is :Date.