MSPS Complaint Form

	I. Complainant
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State	<please select>Alabama Alaska Arizona ArkansasCalifornia Colorado Connecticut DelawareFlorida Georgia Hawaii IdahoIllinois Indiana Iowa KansasKentucky Louisiana Maine MarylandMassachusetts Michigan Minnesota MississippiMissouri Montana Nebraska NevadaNew Hampshire New Jersey New Mexico New YorkNorth Carolina North Dakota Ohio OklahomaOregon Pennsylvania Rhode Island South CarolinaSouth Dakota Tennessee Texas UtahVermont Virginia Washington West VirginiaWisconsin Wyoming Invalid Input
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	II. Alleged Violator (please include as much information as possible)
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State	<please select>Alabama Alaska Arizona ArkansasCalifornia Colorado Connecticut DelawareFlorida Georgia Hawaii IdahoIllinois Indiana Iowa KansasKentucky Louisiana Maine MarylandMassachusetts Michigan Minnesota MississippiMissouri Montana Nebraska NevadaNew Hampshire New Jersey New Mexico New YorkNorth Carolina North Dakota Ohio OklahomaOregon Pennsylvania Rhode Island South CarolinaSouth Dakota Tennessee Texas UtahVermont Virginia Washington West VirginiaWisconsin Wyoming Invalid Input
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	III. Nature of Complaint Identify, in as much detail as possible, the details of your complaint. Include dates of the basis of the complaint and indicate whether it continues. To the extent possible, please identify the section of the practice Act (Article 20) or other authority supporting the violation.
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	IV. Documentation of Complaint Documentation includes photos, survey documents, advertisements, other evidence.
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	V. The Alleged Violation Includes:
Alleged Violation	Using the term Professional Surveyor without being licensed. Has used the seal of another Professional Surveyor or other licensed Professional. Has an expired, suspended or revoked license. Has acted in a manner that may cause confusion on the part of the public. Has misrepresented a material fact or omitted a fact which is likely to mislead or deceive a consumer. The entity holds itself out as a professional surveying firm without having two-thirds of the principals as licensees. Invalid Input
Other (include explanation):	Invalid Input
	VI. Additional Support and Witnesses
Name 1	Invalid Input
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State	<please select>Alabama Alaska Arizona ArkansasCalifornia Colorado Connecticut DelawareFlorida Georgia Hawaii IdahoIllinois Indiana Iowa KansasKentucky Louisiana Maine MarylandMassachusetts Michigan Minnesota MississippiMissouri Montana Nebraska NevadaNew Hampshire New Jersey New Mexico New YorkNorth Carolina North Dakota Ohio OklahomaOregon Pennsylvania Rhode Island South CarolinaSouth Dakota Tennessee Texas UtahVermont Virginia Washington West VirginiaWisconsin Wyoming Invalid Input
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State	<please select>Alabama Alaska Arizona ArkansasCalifornia Colorado Connecticut DelawareFlorida Georgia Hawaii IdahoIllinois Indiana Iowa KansasKentucky Louisiana Maine MarylandMassachusetts Michigan Minnesota MississippiMissouri Montana Nebraska NevadaNew Hampshire New Jersey New Mexico New YorkNorth Carolina North Dakota Ohio OklahomaOregon Pennsylvania Rhode Island South CarolinaSouth Dakota Tennessee Texas UtahVermont Virginia Washington West VirginiaWisconsin Wyoming Invalid Input
Zip	Invalid Input
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State	<please select>Alabama Alaska Arizona ArkansasCalifornia Colorado Connecticut DelawareFlorida Georgia Hawaii IdahoIllinois Indiana Iowa KansasKentucky Louisiana Maine MarylandMassachusetts Michigan Minnesota MississippiMissouri Montana Nebraska NevadaNew Hampshire New Jersey New Mexico New YorkNorth Carolina North Dakota Ohio OklahomaOregon Pennsylvania Rhode Island South CarolinaSouth Dakota Tennessee Texas UtahVermont Virginia Washington West VirginiaWisconsin Wyoming Invalid Input
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	VII. Attest I swear and attest the foregoing information is true to the best of my knowledge.
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State	<please select>Alabama Alaska Arizona ArkansasCalifornia Colorado Connecticut DelawareFlorida Georgia Hawaii IdahoIllinois Indiana Iowa KansasKentucky Louisiana Maine MarylandMassachusetts Michigan Minnesota MississippiMissouri Montana Nebraska NevadaNew Hampshire New Jersey New Mexico New YorkNorth Carolina North Dakota Ohio OklahomaOregon Pennsylvania Rhode Island South CarolinaSouth Dakota Tennessee Texas UtahVermont Virginia Washington West VirginiaWisconsin Wyoming Invalid Input
Zip	Invalid Input
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