Fillable COMPLAINT FORM *An electronic version of this form

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COMPLAINT FORM *An electronic version of this form

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Your Full Name: Residence Address: Residence and Mobile Phone Numbers:
Occupation: Business Address: Business Phone:
I declare I have a complaint against:
Full Name of Suspect: Suspect’s Address: Suspect’s Phone:
Business Name: Business Address: Business/Cell Phone:
The following documentation supports my allegation and is incorporated and made a part of this
complaint:
Advertising materials
Contract or Agreement
Cancelled check(s) (Front and Back)
Promissory Note, Deeds, and Deeds of Trust
Cash receipt(s)
Escrow instructions, loan documents, amendments and closing statements
Correspondences between you and the suspect(s) (Letters, E-mails, Faxes)
Copies of all documents which relate to your complaint which are not listed above.
Copies of any civil complaints filed on behalf of you or others.
Other: Please list and describe:
COUNTY OF SAN DIEGO
REAL ESTATE FRAUD SECTION
COMPLAINT FORM
*An electronic version of this form that can be filled in is available upon request by e-mailing a
request to: REForm@sdcda.org
Date(s) of Transaction: Places Where Ttransaction(s) Occurred (Address, City, State):
Value of real property (ies) taken: Location of property (ies) taken:
Have you or any other victim filed a civil action (lawsuit) in any court in this matter?
No
Yes If yes, please provide copy of court documents and the date of filing (include case
number).
Have you filed this complaint with another law enforcement or consumer protection agency?
No
Yes If yes, provide the name, address and phone number of agency, and the person
handling the case. Please also list the status of that case/investigation.
Have you contacted the suspect(s) or business regarding your complaint and demanded
restitution of your funds?
No
Yes If yes, name of person you contacted, the date(s) contact(s) made, and result.
Have you had a previous business or personal relationship with the suspect(s), firm or
controlling person?
No
Yes If yes, indicate the nature of the relationship, the duration and whom it was with.
List names, addresses and phone numbers of other individuals who may have further knowledge
of this matter. Have you contacted them? When?
If your complaint involves a real estate loan (mortgage), provide the name and address of the
mortgage company, lender, broker, escrow company and title company.
Are you willing to appear in court as a witness to this complaint, and truthfully testify to the
allegations made in this complaint? Yes No If no, give reason.
NOTE: Section 148.5(a) of the California Penal Code states:
“Every person who reports to any peace officer listed in section 830.1 or 830.2,
district attorney, or deputy district attorney that a felony or misdemeanor has
been committed, knowing the report to be false, is guilty of a misdemeanor.”
I declare under penalty of perjury under the laws of the State of California that the
foregoing statements and photocopies of attached documents are true and correct.
Date: ____________________ __________________________________________
Signature of Complainant
Please attach your summary statement of facts to this complaint form. If additional room is
needed to answer any of the above questions, feel free to attach additional sheets.
6/8/21
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COMPLAINT FORM *An electronic version of this form

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Completed 3 May 2022

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