Official Complaint Form

Official Complaint Form

MN Board of Private Detective & Protective Agent Services
Complaint Form Instructions
- The Board of Private Detective and Protective Agent Services cannot process anonymous complaints. The entire form must be filled out completely in order for Board staff to process the complaint.
- Complete the sections below with current addresses and phone numbers for both parties.
- In your statement, please include names, dates, times, any witness information including contact information, and any other information you think may be relevant.
- Attach any additional documentation (photographs, screenshots, audio/video files, etc.) to support your complaint.
- You must sign the form to authorize release of information before submitting to the Board.
- Complainant Full Name*
  
  First NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number*
  Please enter a valid phone number.
- Email*
  example@example.com
- Respondent (Person or Company complaint is about)*
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- License Number (if applicable)
- Under Minn. Stat. 13.41 and 13.39 the information you submit as part of your complaint may be classified as public, private or confidential data based upon the outcome of the complaint investigation and any legal proceedings. Public data is available to members of the public at any time and for any reason. Private data is available to the subject of the data, to those authorized access by law, court order, your consent or to the extent needed to be used to investigate the complaint. Confidential data is not available to anyone that does not have the need to know it to investigate the complaint unless as otherwise required or authorized by law. As a general matter complaint data will be confidential only while the investigation into it and any related legal proceedings are pending.
- Do you authorize the release of your statement? More information will appear once a selection is chosen:*
  
  YesNo
- I hereby authorize the Minnesota Board of Private Detective and Protective Agent Services ("Board") to provide a copy of my Statement (including my name), a summary of its contents, and any documentation I provide in support of my Statement, at the Board's discretion, to the Respondent listed above. I also hereby authorize the Board to release this information to a third party in the course of the Board's investigation of my complaint. I am willing to appear as a witness at a hearing if the Board determines there is cause to warrant disciplinary action against the Respondent.
- I hereby decline to authorize the release of my Statement, a summary of its contents, my name, and any documentation I provide in my Statement to the Respondent. I understand that if I do not want the aforementioned released to the Respondent or if I do not want to be called as a witness at a disciplinary hearing against the Respondent the Board may dismiss the complaint.
- Signature*
- Date*
  
  MonthDayYear
  Date
- Please describe the complaint here.*
- File Upload (if applicable)
  
  Documents, photos, videos, etc
  Cancelof
- I understand I am not legally required to complete or return this form or provide the data I submit as part of this complaint. If I do not complete this form and provide the data I understand the Board may not have any basis to investigate the complaint and that if I do provide the data it will be used for that purpose and any other allowed by law. The data may be used to properly evaluate and investigate this complaint, and if necessary, submit this information in any civil, criminal or administrative legal proceeding. I authorize the Board, its agents and/or agents of the Attorney General's Office representing the Board to disclose this information to those whom they reasonably believe have a need to know including law enforcement, parties to any disciplinary or civil proceeding, including the subject of the complaint if necessary. I understand and consent to the fact this data may as required by law be obtained by the subject of the complaint and/or third parties or members of the public. By signing this form I agree that substance of the complaint may be explained to the subject of the complaint as a basis for further investigation.
- Signature of Complainant*
- Date*
  
  MonthDayYear
  Date
- Should be Empty: