Taxpayer Protection Bureau - Complaint Form
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OFFICE OF THE ATTORNEY GENERAL ERIC T. SCHNEIDERMAN
STATE OF NEW YORK DEPARTMENT OF LAW
Taxpayer Protection Bureau – Complaint Form
The Taxpayer Protection Bureau investigates misconduct by private companies or individuals
seeking to defraud the State of New York. The Bureau recovers funds lost to the government
through such false or fraudulent conduct by investigation and litigation.
To report misconduct of this type, please complete this entire form. Either submit the form
electronically or by mail, filling out the form using type or clearly printing in blue or black ink.
COMPLAINANT:
Name:____________________________________________________
Address:_____________________________________________________________________
City/Town:_________________________________________ Zip Code:__________________
Phone:_____________________________
Email Address:
COMPLAINT:
Has the government been the victim of false or fraudulent conduct?
Yes
No
Identify the government agency or subdivision that was victimized: _______________________
About how much money has the government lost? $___________________________
Individual/Business you are complaining about:____________________________________
Address (if known):____________________________________________________________
City/Town: __________________________________ Zip Code: _______________________
Have you consulted an attorney?
Yes
No
Is there any legal action pending related to the facts of this complaint?
Yes
No
TB001 - (rev. 6/16)
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