Claim Form - Illinois Dealer Recovery Trust Fund Board printable pdf download

Claim Form - Illinois Dealer Recovery Trust Fund Board

ILLINOIS DEALER RECOVERY TRUST FUND

BOARD CONSUMER CLAIM FORM

INSTRUCTIONS FOR FILLING OUT THE CLAIM FORM:

In order for your claim to be reviewed, you must provide all the information requested

IN WRITING to the Illinois Dealer Recovery Trust Fund Board (Board). If any of the

requested information is unavailable, please state that the information is unavailable to you

and explain why.

Please type or print your claim form in blue or black ink. If additional space is needed to

answer any question, please attach separate sheets of paper to this claim form showing on

the separate sheet the number of the question you are answering.

Please include COPIES, NOT ORIGINALS, of the documents requested, and any other

documents that support your claim. PLEASE use ONE SIDE 8 1/2 x 11 inch PAPER

ONLY.

Within 30 days of receipt of your Claim Form, Board will notify you in writing whether

your Claim Form is complete or whether additional information is required to process your

Claim Form. A copy of your Claim Form will be provided to the Dealer/Lessor-Retailer

who is the subject of your claim.

The Claim Form begins on the next page. You do not need to include this instruction page

when you send in your completed Claim Form. Return your completed Claim Form along

with copies of the documents that support your claim to:

Illinois Attorney General’s Office

Consumer Fraud Bureau

500 S. Second Street

Springfield, IL 62701

217-782-1090

Fax 217-782-1097

1-800-243-0618 (Toll free in IL)

TTY: 1-877-844-5461

Claim Form - Illinois Dealer Recovery Trust Fund Board