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.

Please read the below terms carefully*

1. I certify that the information provited in my complaint, including my identity and any factual statements or allegations are true and correct to the best of my knowledge, information and belief.

2. I certify that I have authorized the Allegheny County District Attorney's Office to contact the party(ies) against which I have files a complaint; and, that I further authorize the party(ies) against which I have files a complaint to communicate with and provide information related to my complaint to the District Attorney's Office.

3. I certify that I have authorized the Allegheny County District Attorney's Office to transfer my complaint, and any or all of my attachments related to it, to another federal, state, local or other agency which may have jurisdiction over this matter.

4. I understand that a person who knowingly makes any written false or fictitious statement or files a false or fictitious report to law enforcement authorities is subject to criminal prosecution.

5. By submitting this form I am agreeing to all of the above points.

I agree to the terms above.

Electronic Signature*

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

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