Real Estate Fraud Complaint Form
ADVERTISEMENT
1
2
3
4
5
6Office of the District Attorney
County of San Bernardino
REAL ESTATE FRAUD
COMPLAINT FORM
or
PLEASE PRINT
TYPE (If any section of this form is not legible, it may cause a delay in processing your complaint.)
Your full name (
Residence address (
)
Residence phone no.
Identifies you as the
street/city/state/ zip
1
2
4
complainant)
Call blocking? yes ____ no
____
Cell no.
5
Primary Language:
Business phone no.
3.
6
Occupation
Date of birth
Business address
Social security no.
(street/city/state/zip)
7
8
9
10
Driver‟s license no.
11
Male __ Female __
Were you referred to us? Yes _ No _
Have you ever filed a complaint with us before? Yes _ No _
If yes to # 13, please
12
13
14
If yes, by whom & when?
If yes, who did you file against and when?
provide the case no.
_______________________________
_________________________________________________
___________________
_______________________________
_________________________________________________
___________________
_______________________________
_________________________________________________
___________________
Address of the real property in question (include parcel no. if known):
Approximate dollar
Does the property
15
16
17
amount involved (loss):
or loan involve
______________________________________________________________
HUD?
______________________________________________________________
Yes ___
No ___
______________________________________________________________
I declare I have a complaint against:
Address
Residential, business
(residential & business, if known):
18
19
20
(full name of person, then their business,
or cell phone number:
company, or firm affiliation)
a)
_____________________________________________
a)
________________
a)
___________________________
_____________________________________________
________________
___________________________
_____________________________________________
________________
___________________________
b)
_____________________________________________
b)
________________
b)
___________________________
_____________________________________________
________________
___________________________
_____________________________________________
________________
___________________________
c)
_____________________________________________
c)
________________
c)
___________________________
_____________________________________________
________________
___________________________
Full name of notary
Notary employed by:
Employer‟s address:
Employer‟s phone no.:
(
if involved and
21
22
23
24
):
not listed above
YOU MUST SIGN AND DATE PAGE 6 OF YOUR COMPLETED FORM
WHETHER OR NOT YOU HAVE ADDITIONAL STATEMENT PAGES ATTACHED
Page 1 of 6
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal