File a Liquor or Tobacco Complaint
Complaint Form
Sign in to Google to save your progress. Learn more
Email *
Name of Business
Business Location
Date Incident Occurred
MM
/
DD
/
YYYY
Time Incident Occurred
Time
:
Synopsis of Complaint
Complainant Name and Contact Email or Phone Number
Would You Like to Remain Anonymous
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of State.co.us Executive Branch.

Does this form look suspicious? Report

Google Forms