General Tip and Complaint - North Carolina Secretary …

North Carolina Secretary of State

Tip and Complaint Form

This form is provided as a general tip and complaint form for reports regarding business entities or individuals that are either improperly

filing documents with the agency or whose misconduct is subject to regulation by the agency. This form may also be utilized to notify

the agency of misuse or intentional damage to the property of the agency, especially including matters involving filed document(s) and/

or database integrity. For a more specific form, please visit our home page at and click on the specific division with

which you are filling the tip and complaint.

Important: This form may be filled out online and then printed or printed and filled out by hand. Either method requires a copy be mailed to the address at the

bottom of this form.

Filer Information

First Name

Last Name

Apt. #

Street Address

City

State

Zip Code

Daytime Phone Number (include area code)

Evening Phone Number (include area code)

Email

Person(s) or Organization(s) About Whom Tip and Complaint Is Provided

Name(s)

Organization(s)

Position(s) of person(s) (if applicable)

Describe Your Tip and Complaint (if necessary, attach additional sheets)

Date of Event

Describe Your Tip and Complaint (if necessary, attach additional sheets) - Continued

Signature - I acknowledge that all of the above information is true and accurately reflects the

matter, to the best of my knowledge.

Date

Signature

Return this form to:

NC Secretary of State

General Counsel Office

PO Box 29622, Raleigh, NC 27626-0622

Print Form

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download