Verified Complaint Form printable pdf download

Verified Complaint Form

WYOMING BOARD OF CERTIFIED PUBLIC ACCOUNTANTS

2020 Carey Avenue, Suite 100

Cheyenne, WY 82001

(307) 777-7551 FAX (307) 777-3796

VERIFIED COMPLAINT

INSTRUCTIONS:

Please type or print clearly in ink, fill out all applicable sections of this form fully and accurately, attach legible

copies of all other documents relating to your complaint. You must provide all information which you know or can

discover with reasonable investigation. For assistance in filling out or filing this Complaint, contact the Wyoming

Board of CPA’s. If more space is needed, attach extra sheets.

COMPLAINANT(S)

NAME(S): (Mr.) (Ms.) _________________________________________________________________________

ADDRESS: __________________________________________________________________________________

CITY, STATE & ZIP CODE:____________________________________________________________________

TELEPHONE: (HOME) __________________________ (BUSINESS) __________________________________

OCCUPATION(S) :____________________________________________________________________________

REGISTRANT COMPLAINED ABOUT

1. Name ____________________________________________________________________________________

Firm Name _______________________________________________________________________________

Address ________________________________________________Telephone _________________________

Persons who were witnesses to the complained-about transaction(s) or who otherwise are likely to have first hand

knowledge of the matter(s):

Name _____________________________________

Name ________________________________________

Address ____________________________________

Address ______________________________________

____________________________________

______________________________________

Telephone __________________________________

Telephone ____________________________________

Verified Complaint Form