Ellen F. Rosenblum
OREGON DEPARTMENT OF JUSTICE
Deputy Attorney General
PLEASE NOTE T HE FOLLOWING:
Under Oregon Law, the Attorney General cannot act as your private attorney or give you legal advice. Deadlines may prevent you from
starting a lawsuit if you wait too long, you may wish to contact a private attorney. Filing this complaint does not change any deadlines.
1. PLEASE COMPLETE THIS FORM USING DARK INK. TYPE OR
2. RETURN THIS FORM ALONG WITH COPIES OF ALL SUPPORTING
. DO NOT SEND YOUR ORIGINALS!
INFORMATION ABOUT YOU – FIELDS MARKED BY AN ASTERISK * ARE REQUIRED.
-I would like to receive FRAUD & SCAM ALERTS. (Email address required)
-I am not requesting action on this complaint -I am over 65 years of age -I am under 30 years of age
-English is not my first language -I am a Veteran -I would like info on Veteran’s Benefits
EPENDING ON THE TYPE OF BUSINESS INVOLVED
THERE MAY BE OTHER STATE AGENCIES THAT CAN HELP
FOR A COMPLETE LIST OF AGENCIES, PLEASE VISIT - HTTP://WWW.OREGON.GOV/PAGES/A_TO_Z_LISTING.ASPX
Please provide information about the business or person in which you are submitting the complaint about.
IF YOU PAID BY CREDIT CARD, THE CARD ISSUER MAY OFFER RELIEF OR PROTECTION. CONSIDER CONTACTING YOUR CREDIT CARD COMPANY.
Type of Service or Transaction:
-M otor Vehicles -Home & M ortgage -Phone, Internet & TV
-ID Theft & Data Breaches
If your complaint is about TOWING, provide the License Plate #:
State: ___________ Plate #: ___________________________
If your complaint is about a WEBSITE, provide the Website
If you have an ACCOUNT with this business, provide the
Account #: ______________________________________
Whom have you contacted concerning your Complaint?
Business Name: __________________________________
ARE YOU REPRESENTED? -YES -NO
DM# 8406566 | REV 07/14/19
ATTO RN EY S ’ NAME: ________________________________
PHONE #: _______________________________________