Submitted by lushenejj on Tue, 2023-11-28 11:02 Public Records Disclosure Your complaint is a public record under the Washington State Public Records Act (RCW 42.56). Your complaint may be released if someone requests it. If you provide identifying information in your complaint, your complaint is not anonymous. We may release your identifying information (including your name and contact information). You can choose to have your identifying information removed. Please note that this does not stop the release of your information as part of a court case or subpoena. Release Information? * Do not release my identifying information in response to a request for public records It’s OK to release my identifying information in response to a request for public records Your Information Full Name(s) * Mailing Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Residence Address Different than mailing address Address for Residence City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Telephone E-Mail Address Whom Are You Filing A Complaint Against? Name(s) * Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Telephone Email Whom did you contact? Complaint/Problem What did the transaction involve? * Wire, money order, or money transfer Virtual currency Currency exchange If applicable, are you a Buyer Seller Date transaction occured Year Year20142015201620172018201920202021202220232024 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Amount of transaction What happened? * Please describe what happened. Be as specific as you can. Can you give us copies of documents and correspondence relevant to your complaint? Yes No Have you tried to resolve the issue? Yes No Additional Questions How should we send you updates about your complaint? Email US Mail Are you on active duty in the armed forces, or a dependent of someone who is? Yes No Are you submitting this complaint for someone else? Yes No If you are submitting this complaint for someone else, do you have that person’s permission to communicate with us about their complaint? We’ll need that person’s written, signed permission to communicate with you about the complaint. Yes No If you are not a party to the transaction described in the complaint, what is your involvement? Do you have an attorney? If you choose yes, we will communicate with you through your attorney, rather than with you directly. Yes No Attorney’s Name Name of Law Firm Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Telephone Email If you want us to contact your attorney, how should we contact them? Email US Mail How did you hear about DFI? Declaration Full Name * Date *
