CHECKLIST FOR SUBMITTING A COMPLAINTTO CONSUMER FRAUD FOR REVIEW FOR CRIMINAL PROSECUTION

The information requested below is needed to accurately assess your case for possible violations ofcriminal laws of the State of Texas. We recommend that you consult with your own private attorney to explorepossible civil remedies. Keep in mind that civil and criminal actions are completely independent. Criminalcharges WILL NOT be presented to gain advantage in a civil matter, to obtain restitution, or to forceperformances of a contract.

Please provide accurate, complete, and legible information, preferably typewritten. When you deliverdocuments to our office, always include a reference to our case number. DO NOT send your original and/oronly copy of any document to this office; send photocopies and keep the originals in your file.

Please provide the following information.

1. Your Name: Date of Birth:----------------------------- ---------Address: City: State: __ Zip Code: _

Phone: (Home) ~, (Work) ~ _

(Cell) ~ Drivers License No.: _

Email Address: _

2. Report Against:Name of Person: Company: _

Address: City: State: Zip Code: _

Phone: ~ Drivers License: Social Security: _

Physical Description: Race: Sex: __ Height: Weight: Age: _

3. How did you meet the person or business you are complaining against? _

4. Address where the offense(s) took place.

5. Have you complained to the suspect person(s) or business? YES NO__If yes, who did you contact and what was their response?

6. Total value of property taken. Also describe any reimbursement received.

7. List of witnesses, including current addresses and telephone numbers, who can verify your version ofthe facts.Witness Name: Address: Phone:

8. List of other known victims:

Victim Name: Address: Phone:

9. Name of any other agency to which you reported this matter, along with the name and telephone numberof the person you dealt with.Name: Agency: Phone:

10. Did you sign a contract? YES _NO __ If so, submit a copy of all contracts.

11. Copies (not originals) of relevant documents corroborating your version of the facts, such as contracts,invoices, reports, bank records, emails, letters, faxes, and photos. When copying checks, remember tocopy the backs of the negotiated checks.

12. Copies of witnesses' statements, if any.

13. Is there a civil lawsuit pending? If so, furnish the cause number and court where the case is pending andthe attorney's names.

14. Summary statement of facts, typewritten. (If handwritten, the summary must be LEGIBLE)a) Recite the details of the offense(s) in the order in which they occurred. Answer the questions:

Who? What? Where? How? Why? Include names and dates as well as references todocuments provided.

15. Complete and return the NOTARIZED certification form attached. (Note: Most banks offer freenotarization services for their customers)

As you can see, requesting criminal prosecution is a serious and time-consuming matter that willrequire your full cooperation and a large measure of patience. Get organized and then be prepared toassist us by explaining your complaint further, if requested to do so. Understand at the outset that, ifthis office undertakes a full investigation, it is likely to be a slow, tedious process that could take ayear or more to complete. If an indictment is then obtained, you can expect many additional monthsof waiting before the case is resolved and it may be necessary for you to come to court to testifyagainst the person(s) or business you have complained. These comments are not meant to discourageyou, but to prepare you for what is ahead. We will need your patient cooperation.

HARRIS COUNTY DISTRICT ATTORNEY'S OFFICECONSUMER FRAUD SECTION-1319 PRAIRIE ST. STB 599 ..5DO:3EfFt,~N S·lt. l:iJoHOUSTON, TX. 77002 I

Phone: (713) 274-5555

As soon as your report has been reviewed, we will notify you as to what action may be taken onyour case.

STATE OF TEXAS §

§ AFFIDAVITCOUNTY OF HARRIS

I CERTIFY THAT THE INFORMATION WHICH I FURNISH THE HARRIS COUNTY DISTRICTATTORNEY'S OFFICE IN THIS COMPLAINT IS TRUE AND CORRECT TO THE BEST OF MYKNOWLEDGE AND BELIEF, AND IS FURNISHED FOR THE SOLE PURPOSE OF INSTITUTINGCRIMINAL PROSECUTION IN THE EVENT INVESTIGATION INDICATES CRIMINAL ACTIVITY.I UNDERSTAND THAT, ALTHOUGH A COURT MAY ORDER RESTITUTION IN A CRIMINALCASE, I AM NOT REQUESTING CRIMINAL PROSECUTION FOR THE SOLE PURPOSE OFRECOVERING PERSONAL PROPERTY OR ANY OTHER THING OF VALUE.

I AUTHORIZE THE DISTRICT ATTORNEY'S OFFICE TO USE THE INFORMATION, WHICH IPROVIDE, IN ANY MANNER DEEMED NECESSARY AND PROPER.

Signature of Complaining Party

Complainant's Printed Name

SUBSCRIBED AND SWORN TO BEFORE ME this _ day of , 20_

Notary Public in and for theState of Texas

My commission expires: _