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Please provide as much information as possible in the blanks below. You may remain anonymous if you wish.

Please review Violation Descriptions.

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Your Information

Name

Address

City

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ZIP

Phone

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Violator Information

Violator's Name

Violator's Address

Violator's City

Violator's State

Violator's Zip

Other Identifiers(SSN, DOB)

Is the Violator

Self-employed
A Business Owner
An Employer of other workers

Type of Violation

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

Describe your complaint

Violators Business InformationProvide information regarding violator's business or employees (names, how they earn income, do they hide income, etc.)

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