Form Ipb001 - Complaint Form - New York State Office Of The Attorney Genera

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COMPLAINT FORM 
Investor Protection and Securities Bureau
Consumer Hotline For Hearing Impaired 
New York State Office of the Attorney General
1 (800) 771­7755  
120 Broadway
 
TDD (800) 788­9898 
New York, New York 10271
ag.ny.gov 
(212) 416-8222 (phone)
(212) 416-8816 (fax)
Instructions for filing a complaint:
Return To: 
Investor Protection and Securities Bureau 
1. Please type or print clearly 
New York State Office of the Attorney General 
2. Please complete the entire form 
120 Broadway 
3. Please enclose copies of any documents relating to this complaint 
New York, New York 10271 
Your Contact Details
First Name
Last Name
Street Address
City/Town
State
Zip
(ex:12345 or 12345­1234)
County
Home Phone
Business Phone
(ex:999­999­9999 or 999­999­9999 x9999)
(ex:999­999­9999 or 999­999­9999 x9999)
Mobile Phone
Email Address
(ex:999­999­9999 )

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