Form Ipb001 - Complaint Form - New York State Office Of The Attorney Genera (Page 4 of 4) in pdf

Form Ipb001 - Complaint Form - New York State Office Of The Attorney Genera Page 4

In submitting this form, complainant understands that (please check each box below):

The Attorney General is not my private attorney, but represents the public in enforcing laws designed to protect the public from

misleading or unlawful business practices. My filing this complaint does not mean that the Attorney General has initiated (or

will initiate) a lawsuit or proceeding on my behalf.

The Attorney General cannot give me legal advice or represent me in court. If I have any questions concerning my legal rights

or responsibilities, I should contact a private attorney.

The Attorney General may send a copy of my complaint and any documents I provide to the person or business about whom I

am complaining and I authorize that person or business to release information concerning my complaint to the Attorney

General.

The Attorney General works with other state, local and federal government agencies to investigate complaints and coordinate

law enforcement and may also share my complaint with them. In addition, the Attorney General may use information from my

complaint in legal proceedings to establish violations of law.

Any false statements made in this complaint are punishable as a Class A Misdemeanor under Section 175.30 and/or Section

210.45 of the Penal Law.

By signing or typing my full name below, I certify that the above complaint is true and accurate to the best of my knowledge

and that any documents attached are true and accurate copies of the originals.

Signature

Date

IPB001 (rev. 10/17)

Form Ipb001 - Complaint Form - New York State Office Of The Attorney Genera Page 4