Connecticut > Statewide > Department Of Consumer Protection > Liquor Control Division
Consumer Complaint - Connecticut
| Consumer Complaint Form. This is a Connecticut form and can be used in Liquor Control Division Department Of Consumer Protection Statewide . |
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CONSUMER COMPLAINT STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION LIQUOR CONTROL DIVISION 165 Capitol Avenue · Hartford, CT 06106 E-Mail: liquor.control@po.state.ct.us Fax Number: (860) 713-7235 Agent Number: (860) 713-6210 WHAT IS YOUR NAME? WHAT IS YOUR DAYTIME TELEPHONE NUMBER (INCLUDING AREA CODE)? WHAT IS YOUR EVENING TELEPHONE NUMBER (INCLUDING AREA CODE)? E-MAIL ADDRESS: STATE ZIP CODE WHAT IS YOUR HOME ADDRESS? STREET ADDRESS CITY MY COMPLAINT INVOLVES THE FOLLOWING LICENSED LIQUOR ESTABLISHMENT: NAME OF BUSINESS STREET ADDRESS CITY PERMIT NUMBER, IF KNOWN NATURE OF COMPLAINT: · SALE TO MINOR(S) · SALE TO INTOXICATED PATRONS · REFILLING · AFTER HOURS · PURCHASE FOR RESALE · UNLAWFUL GAMBLING · PERFORMER CONDUCT · OTHER ACTIVITY (EXPLAIN) CHECK ALL THAT APPLY: ___________________________________________________________ ___________________________________________________________ PLEASE PROVIDE AS MUCH INFORMATION AS POSSIBLE (SPECIFIC DATES, DAYS OR NIGHTS, INDIVIDUAL(S) INVOLVED, BRAND NAMES, WITNESSES, VICTIMS, ETC.): ______________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________ SIGNATURE DATE Attach as many additional pages as needed to complete your complaint. Note: All complaints are public information. By submitting this complaint, you give the Department of Consumer Protection your permission to release a copy of the Consumer Complaint. American LegalNet, Inc. www.FormsWorkflow.com
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