Fraud Allegation Form
May 21, 2013
Fields marked with an asterisk (*) indicate a required field.
*Please provide details of the incident in which you believe fraud, waste or abuse was involved:
*Please provide dates and locations:
*Please list the names of the person or persons, as well as the department in which they work:
*Please describe any evidence you have with as much detail as possible, including relevant ID numbers, such as vehicle tag # or vehicle make/model:
The following section is optional, but we encourage you to provide this information in the event we have additional questions or need additional information. If you do not provide your contact information and observe the fraud, waste or abuse continuing, please contact our office, as it is likely we did not have adequate information to reolve the issue.
Would you prefer to remain anonymous?
A confirmation number will be generated upon submission. Please keep this information available if you care to follow-up on your allegation. Information regarding the status of the investigation will not be released without this number.
Please enter the letters/numbers shown from left to right: