Complaint Form - Utah Department Of Commerce Division Of Securities

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COMPLAINT FORM
UTAH DEPARTMENT OF COMMERCE
DIVISION OF SECURITIES
160 East 300 South, 2nd Floor
P.O. Box 146760
Salt Lake City, Utah 84114-6760
Phone: 801-530-6600 Fax: 801-530-6980
E-mail: securities@utah.gov
Please read the following instructions before filing your complaint.
You may type or print on this form, but please make your responses legible.
It is important for you to respond to each question on this form so that we can fully evaluate your
complaint. If a particular question does not apply to your situation please mark "N/A" or “not
applicable” in the appropriate space.
If you need additional space for any of your responses, please attach additional pages and
indicate to which question the additional pages relate.
Please attach copies of all documents relevant to your complaint. These could include
cancelled checks (both sides), written agreements or contracts, promissory notes, account
statements, emails and other correspondence, prospectuses, sales brochures, etc.
Your complaint will be confidential. However, be advised that under Utah law your complaint
may be subject to release to members of the public under certain circumstances. If you have any
questions about this matter, please contact the Division.
When you have completed this form, please send it (along with any attachments) to the Division
of Securities at the email address, fax number, or mailing address listed at the top of this form.
Please be advised although the Division does work to see that appropriate restitution is paid to
victims of securities fraud, the Division will not act as your attorney for purposes of recovering a
lost investment. Any person who has lost money as the victim of an unlawful securities
transaction should immediately contact his or her personal attorney about the possibility of
bringing a civil lawsuit to recover lost funds.

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