Fillable Complaint 003 Complaint Form no longer numbered.PDF

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Complaint 003 Complaint Form no longer numbered.PDF

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The Complaint 003 Complaint Form no longer numbered.PDF form is 3 pages long and contains:

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1
YACHT AND SHIP BROKER'S
COMPLAINT FORM
==============================================================
COMPLETE THIS FORM IN ITS ENTIRETY AND MAIL TO THE ADDRESS
BELOW.
==============================================================
DATE:
COMPLAINANT
NAME:
First Middle Last
ADDRESS:
Street City State Zip
PHONE:( ) - (day time)
RESPONDENT
NAME:
Person and/or Company
ADDRESS:
Street City State Zip
PHONE:( )
SUBJECT OF COMPLAINT: (Violation)
Has the respondent been notified of the issues in this
complaint?
Yes No
2
If yes, what was the method of notification?
Have you retained Legal Counsel regarding the issues listed in
this complaint? Yes No
Name of Counsel Street and/or Mailing Address
( )
City State Zip Telephone Number
Has court action been filed: Yes No IF SO,
ATTACH A COPY OF EACH COMPLAINT FILED IN COURT AND ANY
SUBSEQUENT COURT PLEADINGS.
=============================================================
NOTE: A copy of this complaint may be sent to the Respondent.
BRIEF DESCRIPTION: (Narrative) Explain the nature of your
complaint. Please type or write legibly. Give facts, details,
dates and full names of all persons and witnesses involved.
If more space is needed, please attach a separate sheet.
ATTACH COPIES OF ALL DOCUMENTS, BILLS, RECORDS,
CORRESPONDENCE, CONTRACTS, ETC., WHICH SERVE TO SUPPORT YOUR
ALLEGATIONS.
3
What action do you expect the Division to take?
I hereby request the Division of Florida Condominiums,
Timeshares, and Mobile Homes, Bureau of Compliance,
to make appropriate investigation into the violation herein
alleged. I understand that the Division may investigate this
complaint pursuant to the provisions of Chapter 326, Florida
Statutes.
Florida Statutes 837.06, False Official Statements: Whoever
knowingly makes a false statement in writing with the intent
to mislead a public servant in the performance of his official
duty shall be guilty of a misdemeanor of the second degree.
Signature of Complainant
Date
BUREAU OF COMPLIANCE
DIVISION OF FLORIDA CONDOMINIUMS, TIMESHARES, AND MOBILE HOMES
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
1940 NORTH MONROE STREET
TALLAHASSEE, FLORIDA 32399-1032
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Complaint 003 Complaint Form no longer numbered.PDF

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Completed 3 July 2020

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