Public Integrity Complaint Form

JOHN J. FLYNN
ERIE COUNTY DISTRICT ATTORNEY
PUBLIC INTEGRITY UNIT
25 Delaware Avenue
Buffalo, New York 14202
Fax Number (716) 858 - 7425

COMPLAINT FORM

Your Contact Information

Your Name: *

Street Address: *

City/Town: *

State: *

ZIP: *

County: *

Home Phone: *

Business Phone:

Your Complaint

Public Agency/Individual you are complaining about: *

Street Address (if known):

City/Town:

State:

ZIP:

County:

Has this matter been submitted to another agency: *

Yes

If so, which agency?:

Is there any legal action pending?: *

Yes

If so, where and what?:

Please briefly describe your complaint below:

Read the following before signing below:

I understand that any false statements made in this complaint are punishable as a Class A Misdemeanor under Section 175.30 and/or Section 210.45 of the Penal Law.

Signature: *

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Date: *

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Your Contact Information

Your Complaint

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