New Mexico Regulation and Licensing Department ALCOHOL AND GAMING DIVISION T o n ey A na ya B uil d i n g ▪ 2 5 5 0 C er r il l o s R oa d ▪ S a nt a F e, N e w M ex i c o 8 7 5 0 5 (5 0 5 ) 4 7 6 -4 8 7 5 ▪ F a x ( 5 0 5) 4 7 6- 4 5 9 5 ▪ ww w.rl d. stat e. n m .u s / AG D Public Comments and Complaints The Regulation and Licensing Department Alcohol and Gaming Division works closely with the Special Investigations Division (SID) of the state Department of Public Safety to enforce the provisions of the Liquor Control Act. Violations of the Act by liquor license holders can result in fines and/or suspension of the license. Three violations within a 12-month period can result in revocation of a liquor license. We welcome public comments, either positive or negative, regarding liquor license holders and their employees. Protecting the people of New Mexico from the often tragic effects of underage drinking, DWI and alcohol abuse requires the active support of all our citizens. Please help us by reporting when you observe a licensed liquor establishment or its employees violating state law or failing in their obligations to the community. In filing a complaint, it is important that you provide us with as much information as possible, so that SID investigators will be able to pursue your complaint. Your name: _______________________________________ Date: _____________ Your Street Address: __________________________________________________ City: ___________________________________ State: _________ Zip: __________ How may we contact you? Phone: ________________________ E-mail: _________________________ We will respect your confidentiality. If you wish to remain anonymous, please check here: _______________ The Liquor License Holder you wish to comment or complain about: Business Name: _________________________________________________________________ Location: ______________________________________________________________________ Street: ____________________________________________ City: ________________________ Type of Business: Bar ______ Restaurant ______ Package Goods Retailer: _______ Other: _______ Revision date: 02/2008 American LegalNet, Inc. www.FormsWorkFlow.com Alcohol and Gaming Division Public Comments and Complaints Date of the Incident: ___________________ Summarize your comment or complaint (attach another sheet of paper if you need more space): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ You may submit your comments or complaints on-line through the RLD website, or mail this form to: Regulation and Licensing Department 2550 Cerrillos Road Santa Fe, NM 87505 Thank you for your help! New Mexico Regulation and Licensing Department ALCOHOL AND GAMING DIVISION Page 2 of 2 Revision date: 02/2008 American LegalNet, Inc. www.FormsWorkFlow.com