Public Integrity Complaint Form

DA seal

MICHAEL J. KEANE
ACTING ERIE COUNTY DISTRICT ATTORNEY
PUBLIC INTEGRITY UNIT
25 Delaware Avenue
Buffalo, New York 14202
Fax Number (716) 858 - 7425

COMPLAINT FORM

Your Contact Information

Your Name

Street Address

City/Town

State

ZIP

County

Home Phone

Business Phone

Your Complaint

Public Agency/Individual you are complaining about

Street Address (if known)

City/Town

State

ZIP

County

Has this matter been submitted to another agency

If so, which agency?

Is there any legal action pending?

If so, where and what?

Describe Your Complaint

Please briefly describe your complaint below

Read the following before signing below

I understand that any false statements made in this complaint are punishable as a Class A Misdemeanor under Section 175.30 and/or Section 210.45 of the Penal Law.

Signature

By checking this box, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form.

Date