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Motor Fleet
: Vehicle Misuse Complaint Form
Vehicle Misuse Complaint Form
Submitter Information
Please fill out the information below.
Name
E-mail Address
Telephone Number
Complaint Information
All of the items below are required to submit the complaint electonically.
* Required Fields
Date of Occurrence
*
Required Format: MM/DD/YYYY
Time of Occurrence
*
Required Format: 4:15 PM
Place / Location
*
City
*
State
*
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Dist of Columbia
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Maryland
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Incident Description
*
Vehicle Information
Please be as thorough as possible.
* Required Fields
License Number
Vehicle Number
Vehicle Make & Model
Driver Name
Department
*
--Select--
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Not Sure
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Administration, Dept of
Administrative Hearings
Agriculture and Consumer Svs, Dept of
Auditor, Office of State
Board of Elections
Commerce, Dept of
Community Colleges
Corrections
Crime Control & Public Safety, Dept of
Cultural Resources, Dept of
Employment Security
General Assembly
Governor, Office of
Health & Human Svs, Dept of
Housing Finance Agency
Information Technology, Office of
Insurance, Dept of
Judicial Branch
Justice, Dept of
Juvenile Justice & Delinquency, Dept of
Labor, Dept of
Lieutenant Governor, Office of
NC State Health Plan
NC State Ethics Commission
Nusing, NC Center for
State Budget, Office of
Personnel, Office of
Public Instruction, Dept of
Revenue, Dept of
Secretary of State, Dept of
State Controller, Office of
Transportation, Dept of
Treasurer, Dept of State
University, Univ Board of Governors
University, Appalachian State
University, East Carolina
University, Elizabeth City
University, Fayetteville State
University, NC A & T
University, NC Central
University, NC School Science & Math
University, NC School of Arts
University, NC State
University, UNC Asheville
University, UNC Chapel Hill
University, UNC Charlotte
University, UNC Greensboro
University, UNC Pembroke
University, UNC Wilmington
University, NC Hospitals
University, Western Carolina
University, Winston-Salem State
Divison, Agency, Branch
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