Attorney General Complaint Florida printable pdf download

Attorney General Complaint Florida

Office of the Attorney General

Please return completed consumer contact form to:

Office of Attorney General Pam Bondi

State of Florida

PL-01, The Capitol

Tallahassee, Florida 32399-1050

The contact information MUST be provided as we correspond via U.S. mail. Incomplete forms cannot

be processed. PLEASE WRITE LEGIBLY. Only

one

business per complaint form.

Person Making Complaint:

Complaint is Against:

Miss/Ms.

Mrs./Mr.

Last Name, First Name, Middle Initial

Name/Firm/Company

Mailing Address

City, County

State, Zip Code

Home & Business Phone, including Area Code

Business Phone, including Area Code

Email Address

Business Email or Web Address

Amount Paid: $

Product or Service involved:

Telephone

Mail

Other

I was contacted by:

Date of Transaction:

Have you retained an attorney?

Yes

Did you sign a contract or other papers, i.e. estimates, invoices, or other supporting documents?

Yes

If you filed complaints with any other governmental and/or consumer agencies about this matter, please list those

agencies:

(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, Florida

Statutes.

2. Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his

official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082, s.775.083, or

s.837.06 Florida Statutes.

Yes

Please 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)

Attorney General Complaint Florida

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