Fraud Reporting Form

2. COMPLAINANT INFORMATION
4. Complainant to remain anonymous?

   1. Yes
   2. No
6. Complainant would like a response?

   1. Yes
   2. No
8. Complainant Name

   First and Last Name

10. I would like to:*

    Select one:

    1. Report an allegation of fraud or abuse by an employee of the City
    2. Report an allegation of fraud or abuse by an employee of the County
    3. Report an allegation of fraud or abuse by a member of the Park Authority Board
    4. Report any other allegation of fraud or abuse
12. Date Submitted
    Date Submitted
14. INFORMATION CONCERNING THE COMPLAINT (PLEASE COMPLETE ONE FORM FOR EACH SEPARATE COMPLAINT)

    Each improper action should be noted separately and supported with reliable and sufficient evidence. Supplying detailed information contributes to a thorough and efficient investigation. This form is designed to help you supply the needed information.

18. Who is the person(s) the complaint is against? (Please provide name, position, agency, division, and phone #)
20. What is the assertion of improper governmental activity? Please describe in detail.
22. When did the event(s) take place? Please include dates, time, and frequency.
24. Where did the event(s) occur?
26. Are there any other persons who might provide information or who witnessed the event? If so, what are their names, positions, agencies, divisions, and their contact information?
28. Is there evidence that can be examined or documentation that can be reviewed? (Please provide any available documentation)
30. How do you know about the improper action? Did you see it occur? Did you see documentation indicating it occurred? Did you hear about it from someone else?
32. What specific law or state regulation has been violated?
34. Please upload supporting documentation, details and ANY and ALL other information available to support the complaints or concerns.
36. Additional File
38. Additional File
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field