Complaint Form • Allegheny County District Attorney's Office

Name*

First Last

Date of Birth*

Best Phone #*

Alternate Phone #

Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City State ZIP Code

Name of person or business complaint is against*

Name of owner/individual of business to whom you notified of your complaint

Address above notified individual

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone of above notified individual

Email of above notified individual

Website

Have you previously filed a complaint with the District Attorney's Office?*

Yes

If Yes, what action was taken?*

List ALL other agencies you have contacted or filed a complaint with on this matter.*

What action was taken?*

Have you retained an attorney?*

Yes

Attorney Information

Name of Attorney*

Attorney Phone*

Attorney Address*

Street Address Address Line 2 City State ZIP Code

Have you filed a legal (private criminal and/or civil complaint) action?*

If yes, in your narrative below state WHEN, WHERE, and WHAT decision was made.

Yes

If your complaint is criminal in nature and involves a police department/officer have you contacted the Chief of Police or an elected official from that municipality with your complaint?*

If yes, explain in your narrative below what action was taken.

Yes

Does this complaint originate from you, a family member or friend being arrested or issued a citation?*

Yes

If yes, what is the status of the charges?*

Narrative*

Please explain your complaint. Try to be brief, but be sure to tell WHAT happened, WHEN it happened, and WHERE it happened. Include witness statements, names, contact numbers. Attach copies of all supporting documents such as contracts, letters, receipts, cancelled checks (front and back), photographs, videos or any other papers that relate to your complaint. Once received your complaint will be reviewed for criminality. If the matter is determined to be civil in nature the District Attorney's Office cannot act as your private attorney.

File

Drop files here or

Accepted file types: pdf, png, jpg, doc, Max. file size: 20 MB, Max. files: 6.

Electronic Signature*

Please type your full name below to serve as you electronic signature.

Complaint Report

Attorney Information

Contact

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