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THE INDIANA LOBBY REGISTRATION COMMISSION
10 West Market St., Ste 1760
Indianapolis, IN 46204
(317) 232-9860

1. Give the name of the person who is the subject of this complaint:
   
   
   
   
2. If known, give the phone number and address of the person who is the subject of this complaint:
   
   
   
   
3. Please state the nature of your complaint (it is important to be as specific as possible and to present as many facts as possible. You may attach an additional sheet, if necessary):
   
   
   
   
   
   
   
   
   
   
4. Please give your full name and personal contact information (so that we may discuss this complaint with you):

Signed (Complainant):_____________________________________.

Date filed with ILRC:___________________.