Title Page (Agency Letterhead) ) (COMPLAINANT) : (Complainant's Address) : (Complainant's City, State, Zip): ) Complainant : ) ) and ) ) ) AGENCY CASE NO.___ (AGENCY HEAD) : (Title) : (Agency Name) ) OTHER NUMBERS (Agency Address ) (P.O. Box) ) (City, State, Zip) ) Agency : INVESTIGATIVE REPORT
This page was last modified on November 8, 1999.