Civil Complaint Service Requirements Checklist Form
Please complete all sections to ensure your civil complaint service request can be reviewed and processed efficiently.
Complainant's Full Name
*
First Name
Last Name
Complainant's Email Address
*
example@example.com
Complainant's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Respondent's Name or Entity
*
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Incident
*
Brief Description of Complaint
*
Have you attached all supporting documentation?
*
Yes
No
Upload Supporting Documents (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Preferred Method of Contact
*
Email
Phone
Submit
Should be Empty: