Form P-Complaint - Complaint Involving Intrastate Motor Carrier Operations
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3P-Complaint
(Rev. 11/14)
DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
A
uthorized by the Motor
MICHIGAN PUBLIC SERVICE COMMISSION
Carrier Act, Act 254 P.A.
MOTOR CARRIER DIVISION
1933, as amended.
P. O. Box 30221
Violation of the Motor
Lansing, Michigan 48909
Carrier Act may result in a
fine or revocation of
operating authority.
COMPLAINT INVOLVING INTRASTATE MOTOR CARRIER
OPERATIONS
For assistance with this complaint call (517) 284-8120
Section 1: BASIC COMPLAINT DESCRIPTION: Select one or more of the following categories which pertain to your
complaint about the services provided or the operations conducted by the Complainant. Please complete each of the requested
areas of information pertaining to the category to the best of your ability. Where you need more space to enter your response,
you may continue on and submit additional pages with this form.
Ỏ HOUSEHOLD GOODS MOVE - Complete Section 2, Proceed to Section 3
Ỏ COMPLIANCE WITH MOTOR CARRIER SAFETY REGULATIONS – FAILING TO OPERATE IN A SAFE
MANNER – Complete Section 2, Proceed to Section 4
Ỏ CARRIER CONDUCTING MOVES WITHOUT OPERATING AUTHORITY (Haul for Hire Violations) -
Complete Section 2, Proceed to Section 5
Ỏ
OTHER – Complete Section 2, Proceed to Section 6
Section 2:
IDENTIFICATION OF COMPLAINANT (Person/Carrier Filing Complaint)
MPSC Authority Number: _________________
MC Authority Number: __________________
Complainant’s Name: __________________________________ Contact Name: _________________________________
Address: _________________________________________________________________________________________
City: _________________________________________________________ State:______ Zip Code: ______________
Telephone Number: (_____) ___________________
Fax Number: (_____) _________________________
Email Address: ____________________________________________________________________________
If you wish to remain anonymous in the complaint, you must indicate so in the complaint letter. Otherwise, your complaint,
including your name, may be available upon inquiry by any party. AN ANONYMOUS COMPLAINT IS STILL
REQUIRED TO SUBMIT NAME, ADDRESS AND TELEPHONE NUMBER AND YOUR NAME MAY BE
RELEASED TO THE INVESTIGATING OFFICER ASSIGNED TO YOUR COMPLAINT.
IDENTIFICATION OF RESPONDENT (Motor Carrier Being Complained About)
MPSC Authority Number: _________________
MC Authority Number: __________________
Carrier’s Name: _________________________________________________________________________________
Carrier Contact: (if known): _____________________________________________________
Address: _________________________________________________________________________________________
City: _________________________________________________________ State:______ Zip Code: ______________
Telephone Number: (_____) ___________________
Fax Number: (_____) _________________________
Email Address: ____________________________________________________________________________
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