Real Estate Fraud Complaint Form (Page 3 of 6) in pdf

Results of contact:

______________________________________________________________________________________________

If your complaint involves a real estate loan or transaction, please provide the loan/escrow/title/transaction document number

along with the name and address of the lender, escrow, or title company.

______________________________________________________________________________________________

Have you filed a complaint with another law enforcement or consumer protection agency?

Yes__

No__

If Yes, provide the name and address of the agency, phone number, report number, and the name and title of the person handling

the complaint.

______________________________________________________________________________________________

Do you already have a civil or criminal case filed?

Yes ____

No ____

If yes, please provide the attorney‟s name, business

address, phone number, case no., type of case (such as, small claims), and the court jurisdiction. Please provide any results of

the case and attach any court documents.

__________________________________________________________________________________________________________

_____________________________________________________________________________________________________

Is there a family/child/sibling dispute with regard to a Guardianship or Power of Attorney?

Yes__

No__

If yes, provide the name(s) and relation, and attach a

of the Guardianship or POA documents.

COPY

__________________________________________________________________________________________________________

_______________________________________________________________________________________________________

Are you willing to appear as a sworn witness to testify and be cross-examined regarding the allegations made in this

complaint?

Yes__

No__

If no, briefly state the reason:

______________________________________________________________________________________________

List names, addresses and phone numbers of other individuals who may have further knowledge of this matter.

Name

Contact?

Address and phone



____________________________

Yes__

No__

______________________________________



____________________________

Yes__

No__

______________________________________



____________________________

Yes__

No__

______________________________________



____________________________

Yes__

No__

______________________________________



____________________________

Yes__

No__

______________________________________

YOU MUST SIGN AND DATE PAGE 6 OF YOUR COMPLETED FORM

WHETHER OR NOT YOU HAVE ADDITIONAL STATEMENT PAGES ATTACHED

Page 3 of 6

Real Estate Fraud Complaint Form Page 3

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