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Office of Minnesota Attorney General Lori Swanson

Fraud Report Form

The Fraud Report Form is used if you would like to report a fraud or scam.

Step One: Fill out the Form

Please fill out the Fraud Report Form carefully and provide as much information as you can. You may use your computer keyboard to type your information online into each of the boxes. Use the tab key to navigate from box to box. After you have typed your information into each box, you may print the completed form and mail it to our office. (If you prefer, you may print a blank form using this link and write by hand your information onto both sides of the form.)

Step Two: Print and Sign the Completed Form

After you have typed your information online into the boxes, use the Print this Form button at the bottom of the page to print two copies, keeping one for your records. After you print the completed form, be sure to sign it. All complaints require a written signature.

Step Three: Mail the Form to Us with any Attachments.

Attach copies of any relevant documents, such as bills, contracts, canceled checks, correspondence, or advertisements. Please do not send us your original documents. Mail the completed and signed Fraud Report Form to our Office at the following address:

Office of Minnesota Attorney General Lori Swanson
445 Minnesota Street, Suite 1400
St. Paul, MN 55101

Step Four: Our Response.

We will respond to you as quickly as possible after we receive your information. In some cases, we may assist you in locating other government agencies that can best address the problem.

Information about You

Your Name:

Your Street Address:

Your City, State, Zip:

Your Day Phone:

( ) -

Your Cell Phone:

( ) -
Information about the Scammer (if known)

Name of Person or Entity:

Its Street Address:

Its City, State, Zip :

Its Phone Number:

( ) -

Its Website and/or Email Address:

How Were You Contacted

How were you contacted (mail, phone, email, etc.):

Date you were contacted:

If you were called by phone, at which phone number did you receive the call(s)?

( ) -

Is this telephone number registered on the National Do Not Call Registry? Yes      No

Product or Payment Involved (if any)

Product/Service Involved (if any):

Date of Your Payment (if any):

Amount of Your Payment (if any):

Has this amount (if any) been refunded?

Method of Your Payment (if any): (cash, credit card, debit card, wire transfer, reload pack, etc.)

Explanation of What Happened

More room is available on the next page

Questions Continue on the Next Page

  • (If you need even more space, please feel free to attach a separate document with more information.)

Other Agencies You Contacted About this & Result


(If you need more space, please feel free to attach a separate document with more information.)

The information you provide may be used in our efforts to resolve the problem, to communicate with you, and/or to enforce applicable laws. The information may be shared with the party complained against, law enforcement agencies and consumer assistance agencies. You are not legally required to provide this information, but failure to do so may hinder efforts to resolve your problem.

The information I have given you is true and accurate to the best of my knowledge and may be used as stated on this form.

Signature

Date

Please mail completed, signed form (and any attachments) to: Office of Minnesota Attorney General Lori Swanson, 445 Minnesota Street, Suite 1400, St. Paul, MN 55101. Call our office at (651) 296-3353 or (800) 657-3787 with any questions.

Thank you for the opportunity to assist you.

Lori Swanson

Minnesota Attorney General