Your Information

Please enter information about yourself, in the boxes below. While you are not required to enter any information about yourself, your information would be helpful to us, should we need to follow-up with you in this regard.

Name:

Address:

City:

State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:
Enter a zip-code as 5 or 9 numbers, with no dashes, no spaces.

Phone:
Enter a phone number as 10 numbers, with no dashes, no parenthesis, no spaces.

Email:

Referral Information

Please enter information about the person(s) or business(es) you are referring, in the boxes below. Any information you would provide will be helpful.

Name:
*Required

Address:
*Required

City:
*Required

State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:
Enter a zip-code a 5 or 9 numbers, with no dashes, no spaces.

Phone:
Enter a phone number as 10 numbers, with no dashes, no parenthesis, no spaces.

Email:

Other:
Enter any other identifying information.

Is the person you are referring:

• Self-Employed
• A Business Owner
• An Employer of Other Workers
• An Employee
• Other

Type of Fraud:

• Income Tax or Withholding Tax Fraud
• Sales and Use Tax Fraud
• Cigarette Tax Violations
• Motor Fuel - IFTA Violations
• Motor Fuel - Dyed Diesel Violations
• Other Tax Crimes

Please describe your complaint below. Provide any additional information regarding the business or individual that will help us identify them for purposes of an investigation. Details such as address, business name or home address are helpful.

Submit Your Referral