Form Cscl/lce-992 - Statement Of Complaint - Michigan Department Of Licensing And Regulatory Affairs

ADVERTISEMENT

CSCL/LCE-992 (02/13)
Complaint Number-For Office Use Only
Department of Licensing and Regulatory Affairs
Corporations, Securities & Commercial Licensing Bureau
Enforcement Division
P.O. Box 30018, Lansing, MI 48909
Telephone: (517) 241-9202
STATEMENT OF COMPLAINT
INSTRUCTIONS TO THE COMPLAINANT: Please type or print legibly in ink. Read both sides of this form carefully before completing. Be
sure to sign and date the back of this form. This Division has jurisdiction in only certain matters involving consumers and licensees in the
area of occupational professions. It is suggested that you first contact the person or firm about which you have a complaint to see if the
matter can be settled. If this has been unsuccessful, you may want to consult an attorney to determine your civil options, file an action in
Small Claims Court, or contact your Prosecutor. These may be done in conjunction with or instead of filing a complaint with this Department.
YOUR COMPLAINT IS AGAINST
INFORMATION ABOUT YOU
1. Name of Licensee (Company)
7. Name
2. Address (Number and Street)
8. Address (Number and Street)
3. City, State
Zip Code
9. City, State
Zip Code
4. Telephone Number
10. Telephone Number
(
)
(
)
(
)
Day
Evening
5. Name of Person You Dealt With
11. Are you willing to testify in a hearing?
Yes
No
6. License Number (If known)
12. Here is a list of the professions we regulate. Indicate which profession your complaint is against.
Alarm System Contractors
Employment Agency
Pre-Paid Funerals
Architect
Engineer
Professional Employer Organizations
Auctioneers
Forester
Professional Investigators
Barber/Barber Shop
Hearing Aid Dealer
Proprietary Schools
Carnival Ride
Immigration Clerical Assistants
Real Estate Agent/Company
Cemetery
Interior Designers
Real Estate Appraiser
Collection Agency
Investment & Securities
Security Guard Agencies
Community Planner
Land Surveyor
Ski Area
Cosmetologist
Landscape Architect
Unarmed Combat
Cosmetology School/Shop
Mortician or Funeral Home
Vehicle Protection Warranty
CPA/CPA Firm
Ocularist
Other
Electrologist/Manicurist
Polygraph Examiner
13. Have you contacted the above named person or company in writing about your complaint?
Yes
No
If yes, what was the result?
14. Did you file a claim with any other agency, or start civil or criminal action?
Yes
No
If yes, where?
Case Number
What is the current status of that claim?
15.
What do you want the person or company named above to do to resolve the complaint?
For Office Use Only

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Bcs/cd-313 - Waiver Statement Form - Michigan Department Of Licensing And Regulatory Affairs Form Bcs/cd-313 - Waiver Statement Form - Michigan Department Of Licensing And Regulatory Affairs Legal
Form Bcs/cd-530 - Certificate Of Dissolution - Michigan Department Of Licensing And Regulatory Affairs Form Bcs/cd-530 - Certificate Of Dissolution - Michigan Department Of Licensing And Regulatory Affairs Legal
Form Cscl/cd-900 - Mich-elf Cover Sheet - Michigan Department Of Licensing And Regulatory Affairs Form Cscl/cd-900 - Mich-elf Cover Sheet - Michigan Department Of Licensing And Regulatory Affairs Legal
Form Cscl/cd-516 - Certificate Of Amendment To The Articles Of Incorporation (for Use By Ecclesiastical Corporations) - Mi Department Of Licensing And Regulatory Affairs - 2015 Form Cscl/cd-516 - Certificate Of Amendment To The Articles Of Incorporation (for Use By Ecclesiastical Corporations) - Mi Department Of Licensing And Regulatory Affairs - 2015 Business
Form Miosha-300a - Summary Of Work-related Injuries And Illnesses - Michigan Department Of Licensing And Regulatory Affairs Form Miosha-300a - Summary Of Work-related Injuries And Illnesses - Michigan Department Of Licensing And Regulatory Affairs Legal
Form Bcs/cd-510 - Restated Articles Of Incorporation - Michigan Department Of Licensing And Regulatory Affairs Form Bcs/cd-510 - Restated Articles Of Incorporation - Michigan Department Of Licensing And Regulatory Affairs Legal
Form Bcs/cd-602 - Application For Registration Of Insignia - Michigan Department Of Licensing And Regulatory Affairs Bureau Of Commercial Services Form Bcs/cd-602 - Application For Registration Of Insignia - Michigan Department Of Licensing And Regulatory Affairs Bureau Of Commercial Services Financial
Form Uia 1028 - Employer's Quarterly Wage/tax Report - Michigan Department Of Licensing And Regulatory Affairs Form Uia 1028 - Employer's Quarterly Wage/tax Report - Michigan Department Of Licensing And Regulatory Affairs Financial
Entry Of Appearance In An Administrative Hearing Form - Michigan Department Of Licensing And Regulatory Affairs Public Service Commission Entry Of Appearance In An Administrative Hearing Form - Michigan Department Of Licensing And Regulatory Affairs Public Service Commission Legal
Form Fn-1 - Foreign Registration Statement - Department Of Consumer And Regulatory Affairs Form Fn-1 - Foreign Registration Statement - Department Of Consumer And Regulatory Affairs Legal

Related Categories

Parent category: Legal
Download
Go
Page of 2