State of California Department of Alcoholic Beverage Control Complaint Against Licensee · Read Complaint Form Information before completing this form. · Fill in as many of the blanks as you possibly can. · After completing the form, print and mail to the nearest ABC District Office or Department of Alcoholic Beverage Control Attention: Complaint Desk 3927 Lennane Drive, Suite 100 Sacramento, CA. 95834 INFORMATION ABOUT YOU It is not required that you give "Information About You." You may remain anonymous. If you do give personal information, it will not be released outside of the department and will remain confidential. Name: Address: City: State: Zip Code: Phone: (Day): (Evening): INFORMATION ABOUT ABC LICENSED BUSINESS Name of Business: Business Address: City: State: Zip Code: Phone: Name of Owner if known: Nature of Complaint: (Check all that apply) Disorderly House Sales After 2:00 A.M. False Owner Sales to Minors Drink Solicitation Excessive Noise Sales to Obviously Intoxicated Patron Other ______________ Illegal Drug Activities Gambling Prostitution Lewd Conduct Date of incident: Time of incident: Have you contacted the business owner regarding your complaint? Yes No Have you filed this with another law enforcement agency? Yes No If you answer yes, name of law enforcement agency: Other Details: ABC099-E (rev. (09/14) American LegalNet, Inc. www.FormsWorkFlow.com