Preliminary Statement of Complaint
RE COMPLAINING ABOUT:
Real Estate Broker/Sales - Attach any available documents and/or records relevant to the transaction(s) in question, including but
not limited to, the following:
Ɣ Listing Agreement Ɣ Agency Disclosure Form Ɣ Closing Statement
Ɣ Commission Agreement Ɣ Contract of Sale Ɣ Receipts
Ɣ Real Property Management Agreement Ɣ Lease Ɣ Rental Applications
Real Estate Appraiser – Attach appraisal reports(s) and proof of payment.
Private Investigator – Attach advanced statement of service/contract, proof of payment, and investigative reports.
Notary Public – Attach notarized document(s) in question.
Home Inspector – Attach inspection report and proof of payment.
Hearing Aid Dispenser/Business – Attach contract and/or receipt and proof of payment.
Security and Fire Alarm Installer – Attach contract and/or invoice and proof of payment.
Ticket Reseller – Attach complete copies of invoices, receipts, and proof of payment.
Apartment Information Vendor/Sharing Agent – Attach contract, escrow agreement, and proof of payment.
Nails, Beauty and Barber – You may file this complaint at “One-Stop E-Licensing” at: https://aca.licensecenter.ny.gov/aca/
Attach any and all available documents relevant to the transaction(s) in question for the following:
Armored Car Carrier/Guard Coin Processor
Athlete Agent Document Destruction Contractor
Bedding Health Club
Central Dispatch Facility Telemarketer Business
Other: Please Specify
NAME AND ADDRESS OF WITNESS OR OTHER PEOPLE INVOLVED IN COMPLAINT:
NAME (LAST, FIRST, M.I., SUFFIX)
ADDRESS NUMBER AND STREET
CITY STATE ZIP+4 COUNTY
HOME PHONE BUSINESS PHONE CELL PHONE EMAIL ADDRESS
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DOS-1507 (Rev. 6/14)
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