charities@attorneygeneral.gov Charitable Trusts & Organizations Complaint Form Charitable Trusts & Organizations th 14 Floor, Strawberry Square Harrisburg, PA 17120 717-783-2853 www.attorneygeneral.gov Required fields are marked with an asterisk* Your information: Age Group: Are you a veteran? Are you on active duty? Yes Yes Name* No No Under 18 18-34 35-59 60-64 65 and older Mr. Mrs. Address* Ms. Dr. City* State* Zip Code* County* Daytime Phone Number* ( ) Home Phone Number* ( ) Email Address If completing this form on behalf of someone else, please complete the following information: Age Group: Are they a veteran? Are they on active duty? Yes Yes No No Under 18 18-34 35-59 60-64 65 and older Mr. Mrs. Address* Ms. Dr. Name* City* State* Zip Code* County* Daytime Phone Number ( ) Home Phone Number ( ) Email Address Who is the complaint against? Name of charitable organization or fundraising campaign with the salutation* Phone Number: ( Address ) City State Zip Code County Name and/or title of the person calling or writing to you: The purpose for which your donation/contribution was to be used: American LegalNet, Inc. www.FormsWorkFlow.com How were you contacted: Phone Mail Yes No In Person Other Date(s) of contact: Did you agree or pledge to make a donation/contribution? How did you make your donation/contribution? Cash Check Money Order Credit Card If so, how much? $ When did you make your donation/contribution? Did you receive any written solicitation materials, receipts, pledge reminders, decals, membership cards, etc.? Yes No Complaint Information:* Please explain your complaint. You may use additional sheets if necessary. Please print or type clearly. Try to be brief, but be sure to tell us WHAT happened, WHEN it happened, and WHERE it happened. Be specific about any oral statements that were made to you. Describe events in the order in which they happened. Attach COPIES of all solicitations, letters, receipts, cancelled checks (front & back), advertisements and any other papers that relate to your complaint. American LegalNet, Inc. www.FormsWorkFlow.com PLEASE READ CAREFULLY THE ATTORNEY GENERAL CANNOT ACT AS YOUR PRIVATE ATTORNEY The primary function of the Office of Attorney General is to represent the public at large. The Charitable Trusts and Organizations Section will review all complaints received. If additional information is required, you will be contacted. Your complaint will be kept on file with our office and the information may be used to establish violations of Pennsylvania law. This office cannot release any information about a review or investigation it may undertake. General information about the registration or financial status of a charitable organization doing business in Pennsylvania can be obtained by contacting the Department of State, Bureau of Charitable Organizations, toll-free within Pennsylvania, at 1-800-732-0999. I certify that the information provided is true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. YOUR SIGNATURE DATE American LegalNet, Inc. www.FormsWorkFlow.com