72068: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Date of Complaint' and 'Office Number' at the top of the form. This information is crucial for tracking your request.
Fill in the 'FLHSMV/TC Representative’s Name' if applicable, and indicate where the complaint originated from by selecting either 'Victim', 'Law Enforcement', or 'Other'.
If your complaint originated from Law Enforcement or Other, provide detailed contact information including agency name and officer’s name.
Indicate whether a formal complaint has been made with any Law Enforcement entity by selecting 'Yes' or 'No'. If yes, include relevant details such as agency name and case number.
Complete the 'Victim/Complainant Information' section with your full name, address, last four digits of your FL DL/ID number, issue date, contact number, and email address.
Select the type of fraud experienced from the options provided. This helps categorize your complaint effectively.
Provide information about any possible imposters if known, including their names and addresses.
In the final section, detail your complaint thoroughly to ensure all necessary information is captured before submitting.

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