Document Number: ERD-10241-E
Description: This form should be used to file a Public Accommodation or Amusement Complaint.
Comments: This form must be notarized.
Content Contact: Equal Rights Information
Document Attachments:
ERD-10241-E (Electronic Version - Word/136 KB) Fill in online, print and save. You must have MS Word to save the completed form.
ERD-10241 (Print Version - pdf/111 KB) Print and fill in by hand. This version can not be completed online but can be printed and filled in by hand. This format will work with all computer operating systems. This requires the free Adobe Acrobat Reader to view and print the blank form.
*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.
*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page. Links to each specific vendor's site have been provided for you. Thank you.