A Complaint Form (printable) is provided below:
|Name and Address of individual against whom complaint is made:|
|Nature of complaint in detail: (attach additional pages as needed.) |
|Witnesses to incident or situation: (give full names and addresses.)|
|NOTE: LICENSEES ARE NOTIFIED WHEN A COMPLAINT IS FILED AGAINST HIS / HER LICENSE. A COPY OF THE COMPLAINT FORM AND ALL SUPPORTING DOCUMENTS ARE SENT TO THE LICENSEE WITH THE LETTER OF NOTIFICATION.|
|Name, address and telephone number of individual making complaint:|
Subscribed and sworn to before me this ________________ day of __________________ , 20___.
My commission expires on the ________________ day of __________________ , 20___.
Notary Public in and for