Elder Justice Complaint Form

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1 Caller Information

Are you contacting on behalf of self or other?

Other

Self

Anonymous

First Name

Middle Name

Last Name

Your Location Search For Address Start typing an address and use your mouse (touch on phone) or Up/Down arrows followed by Tab/Enter to select your address from the suggested list.

Address Line 1

Address Line 2

City

Zip Code

Phone Number

Email Address

Confirm Email Address

Does the victim know you are calling on their behalf?

Victim does not know

Victim knows

Do you have the victim's consent to call the Attorney General's Office?

I do NOT have the victim's consent

I do have the victim's consent

3 Suspect Information

Suspect Name Unknown

Suspect First Name

Suspect Middle Name

Suspect Last Name

Suspect's Location Search For Address Start typing an address and use your mouse (touch on phone) or Up/Down arrows followed by Tab/Enter to select your address from the suggested list.

Suspect Address Line 1

Suspect Address Line 2

Suspect City

Suspect's Zip Code

Suspect's Phone Number

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4 Complaint Information

Nature of complaint

How can the Attorney General's Office help?

Have you contacted local resources?

Yes

Please name the resource(s)

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5 Acknowledgement

I understand that any information I submit to the Ohio Attorney General's Office is considered public information and may be made available upon request. Once produced, any future dissemination of the information is at the sole discretion of the party with whom the information was shared.

I understand a copy of this form and all documents relating to my complaint may be sent to the individual/business that is the subject of my complaint.

I understand that the Ohio Attorney General cannot serve as and is not my private attorney.

The information provided is true to the best of my knowledge and belief

I Agree

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6 Submit/Clear