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Complaint Form. This is a Maryland form and can be use in Securities Secretary Of State.
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Tags: Complaint, Maryland Secretary Of State, Securities
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Calendar No.
OFFICE OF THE ATTORNEY : GENERAL
JUDICIAL SUBPOENA
Plaintiff(s)
SECURITIES DIVISION
-against- 200 ST. PAUL PLACE
:
20TH FLOOR
:
BALTIMORE, MARYLAND 21202-2020
TELEPHONE: (410) 576-6360
:
Defendant(s)
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COMPLAINT . . . .
............
The purpose of this complaint form is to provide the Maryland Division of
Securities with information necessary for the commencement of a preliminary
THE PEOPLE of your allegations.
investigation OF THE STATE OF NEW YORK Thus, it is important for you to furnish
as much detailed information as possible. All information you provide will
be deemed confidential, and neither the contents nor the source of this
TO
complaint will be publicly disclosed or available for public inspection
unless formal proceedings are instituted.
GREETINGS:
It is important that you attach copies of all written materials (including
checks, contracts, advertisements, pamphlets, and letters or correspondence)
WE COMMAND YOU, that all business
that may relate to your complaint. and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
, on the
, 20
, at
o'clock in the
noon, and at any recessed
The in room
Division appreciates day of interest and cooperation.
your
or adjourned date, to testify and give evidence as a witness in this action on the part of the
(PLEASE TYPE OR PRINT)
INFORMATION ABOUT PURCHASER OR COMPLAINANT (YOU)
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Mr.
Mrs.result of your failure to comply.
Ms.
Witness, Honorable
Dr. _______________________________________________ , one of the Justices of the
__________________
Last
First day of
Middle
Today's Date
Court in Name
County,
, 20
___________________________________________________
Home Address
City
State
Zip
(____)______________
Telephone Number
___________________________________________________
Business Address
City
State
Zip
(____)_____________
Telephone Number
(Attorney must sign above and type name below)
Attorney(s) for
___________________
Trade or Occupation
__________
Approx. Age
Single
Married
Widowed
Divorced
Are you willing to be interviewed by an investigator from this office?
Office and P.O. Address
________
Yes
________
No
Telephone No.:
Are you willing to be a witness if formal proceedings are commenced by the
Securities Commissioner?
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
-against-
Index No.
Calendar No.
:
Plaintiff(s) ________ JUDICIAL SUBPOENA
Yes
________
:
No
:
:
INFORMATION ABOUT SUBJECT OR SELLER (If unknown, please indicate)
:
In what. .company, . corporation, . orDefendant(s) . . . . . . .did you invest:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . association
.........
___________________________________________________________________________
Its Name
Address
Telephone No.
THE PEOPLE OF THE STATE OF NEW YORK
List persons who were involved in this transaction. ( Please use separate
pages or page 6 to set forth any other available information about these
TO
persons.)
____________________________________________________________________________
LastGREETINGS:
Name
First
Middle
Position
Telephone No
___________________________________________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Address
City at the
State
Zip
,
the Honorable
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
____________________________________________________________________________
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Last Name
First
Middle
Position
Telephone No
____________________________________________________________________________
Address
State
Zip
Your failure to comply with this City is punishable as a contempt of court and will make you liable to
subpoena
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
How result of yourlearntoof the investment? (Check more than one if necessary and
did you failure comply.
enclose copies of pamphlets or advertisements if possible).
________
Witness, Honorable
, one of the Justices of the
Personal visit
Court in
County,
day of
, 20
When? _______________________________________________________
Where? ______________________________________________________
Whom? _______________________________________________________
Who else was present? _______________________________________
(Attorney must sign above and type name below)
________
Telephone call
Date? _______________________________________________________
Attorney(s) for
From whom? __________________________________________________
At what address/location was the call received? _____________
_____________________________________________________________
________
Advertising pamphlet/sales letter Office and P.O. Address
Mailed to you at what address/location? _____________________
_____________________________________________________________
2
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
Copy of pamphlet/sales letter enclosed?______________________
:
JUDICIAL SUBPOENA
Plaintiff(s)
Copy of envelope attached?___________________________________
-against-
________
:
Newspaper
Name of paper? ______________________________________________
:
Date? _______________________________________________________
Copy of advertisement enclosed?: _____________________________
Defendant(s)
:
......................................................
THE PEOPLE OF THE STATE OF NEW YORK
________
TO
Radio
Name of station? _________________________________________________
Date? ____________________________________________________________
________
Television
Name
GREETINGS: of station? _________________________________________________
Date? ____________________________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
________ Group sales presentation at the
,
the Honorable
Court
Date of presentation? ____________________________________________
located at
County of
Where? ___________________________________________________________
in room
,
day of
, 20
, at
o'clock in the
noon, and at any recessed
Others on the
present? __________________________________________________
or adjourned date, to testify and give evidence as a witness in this action on the part of the
________
Other (Please specify)
__________________________________________________________________
__________________________________________________________________
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Listresult of your failure to comply.
others who were present when the offers or sales were made to you.
page 6 if necessary).
(Use
Witness, Honorable
, one of the Justices of the
____________________________________________________________________________
County,
day
, 20
NameCourt in
Address of
Telephone
Relationship to
Complainant
(Purchaser) or Seller
(Attorney must sign above and type name below)
What did you purchase or invest in? (Examples: common stock, debenture,
limited partnership interest, investment contract, fractional interest in an
oil and gas lease)
Attorney(s) for
____________________________________________________________________________
____________________________________________________________________________
How many units or shares did you purchase? _________________________________
Office and P.O. Address
Total amount of your investment or loan?
$________ Cash
$________ Check
Other (Please identify) __________________ (Enclose copy of both sides of
3
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
check)
Plaintiff(s)
Calendar No.
:
JUDICIAL SUBPOENA
How was the amount to -againstbe paid: (lump sum, installments, etc.) ______________
:
____________________________________________________________________________
:
Who received the payment from you? _________________________________________
When? _________________________________________________________________
:
Where? ________________________________________________________________
Defendant(s)
:
......................................................
By Mail? ______________________________________________________________
On what dates were the units or shares purchased? __________________________
THE PEOPLE OF THE STATE OF NEW YORK
TO
Did GREETINGS: any type of contract? ________ If so, please enclose a copy.
you sign
Where was it signed (city/county)? ____________________________________
Who elseCOMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
WE was present? _________________________________________________
the Honorable
at the
Court
How were your securities delivered? ________________________________________
located at
County of
If in person:
in room
, on
day of
, 20
, at
o'clock in the
noon, and at any recessed
By whom? the
_________________________________________________________
or adjourned date, to testify and give evidence as a witness in this action on the part of the
When? ____________________________________________________________
Where? ___________________________________________________________
If by mail, please attach envelope and any cover letter.
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Describe any prior business or personal maximum penalty of $50 and all damages sustained as a
the party on whose behalf this subpoena was issued for a relationships/dealings with either
the company or the salesperson who contacted you: __________________________
result of your failure to comply.
____________________________________________________________________________
Witness, Honorable
one of the Justices of the
Please explain in detail your previous investment ,experience (type, date,
Court
County,
day of
, 20
amount):in___________________________________________________________________
____________________________________________________________________________
List any oral representations or promises made to you above and type salesperson:
(Attorney must sign by the name below)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Attorney(s) for
What, if any, statements made to you were untrue? __________________________
____________________________________________________________________________
____________________________________________________________________________
Office and P.O. Address
Who else do you know that invested with the company, corporation, or
association? ______________________________________________________________
____________________________________________________________________________
4
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
,
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
Have you notified or filed a complaint with any of the following agencies?
:
JUDICIAL SUBPOENA
Plaintiff(s)
_____U.S. Securities -against& Exchange Commission
_____Maryland Attorney General
_____Other Federal Agency or Office
_____County or District Attorney
:_____Sheriff's Office
_____Local Police Department
:_____Better Business Bureau
_____Local Newspaper
:
Have you complained to subject or seller?
_____Yes
_____No
If yes, what offer of adjustment Defendant(s)
or explanation was made? _________________
:
......................................................
____________________________________________________________________________
____________________________________________________________________________
HaveTHE PEOPLE OF THE STATE OF NEWfiled a lawsuit in any court? If yes, please
you or any other victims YORK
provide the name of the case/county/case number/ and provide a copy of the
court documents. ___________________________________________________________
TO
____________________________________________________________________________
____________________________________________________________________________
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
Please provide a narrative of the transactions which gave rise to your
located at
County of
complaint. (Use separate sheets or back of this page if necessary).
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
____________________________________________________________________________
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
____________________________________________________________________________a
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as
____________________________________________________________________________
result of your failure to comply.
____________________________________________________________________________
____________________________________________________________________________
Witness, Honorable
, one of the Justices of the
____________________________________________________________________________
Court in
County,
day of
, 20
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
(Attorney must sign above and type name below)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Attorney(s) for
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Office and P.O. Address
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
5
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
____________________________________________________________________________
:
JUDICIAL SUBPOENA
Plaintiff(s)
____________________________________________________________________________
-against____________________________________________________________________________
:
What would you consider to be a satisfactory :solution?
____________________________________________________________________________
____________________________________________________________________________
:
____________________________________________________________________________
Defendant(s)
:
......................................................
_____________________________________________
Signature (Please sign in
THE PEOPLE OF THE STATE OF NEW YORK ink)
TO
__________________________
Date
PLEASE RETURN THIS COMPLETED COMPLAINT AND ALL ATTACHMENTS TO:
OFFICE OF THE ATTORNEY GENERAL
MARYLAND DIVISION OF SECURITIES
GREETINGS:
200 St. Paul Place
20th excuses
WE COMMAND YOU, that all business andFloor being laid aside, you and each of you attend before
Baltimore, Maryland 21202-2020
,
the Honorable
at the
Court
Telephone: (410) 576-6360
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
ADDITIONAL INFORMATION
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
6
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com