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Mail to <br />Minnesota Department of Labor and Industry BuildingContractorCCLD - Enforcement Services Unit <br />mConsumerComplaintForm443LafayetteRoadN. p <br />St. Paul, MN 55155 (This form is only for the use of Minnesota residents.) <br />651)284-5069 <br />PRINT IN INK or TYPE your responses <br />We are requesting your name, addresses and phone numbers so that we can contact you for further information and let you know when our <br />investigation is complete. You are not required to provide this information. However, without it we will not be able to contact you for additional <br />information we might need to respond to your complaint. While we are investigating your complaint, the information you provide about <br />yourself is not public and can only be released to those authorized by law to obtain the information, such as representatives of the <br />Department, staff of the Office of Administrative Hearings or the courts, and anyone having a court order to obtain the information. After the <br />investigation is complete, the information about you might become public, depending on the nature of the complaint and who the complaint is <br />new home construction room addition home improvement other (please specify) <br />REASON FOR COMPLAINT (check one or more) <br />quality of construction failure to complete work failure to pay subcontractors <br />contractual dispute financial misconduct no building permitlinspection <br />licensing issue general conduct/service other (please specify) <br />DETAILS OF MY COMPLAINT (please attach copies of all relevant documents, such as contracts, proposals, change orders, closing <br />statements, correspondence, etc.) (Attach additional sheets as necessary). <br />WHAT I WANT MY CONTRACTOR TO DO TO RESOLVE MY COMPLAINT: (Attach additional sheets as necessary). <br />This material can be made available In different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL -DLI) Voice or <br />TDD (651) 2974198. <br />RBC 21 (5/08)