Weights and Measures Complaint Form

*Weights & Measures does not accept anonymous complaints*

You may also download this form.

First Name

Last Name

Phone

Alternative Phone

E-mail

Name of Business

Address of Business

Date of Incident

Time of Incident

Device Type

(scale, gas pump, etc)

Device Identification

(gas pump number, etc)

Describe the Incident

Do you have the Receipt?

Yes

Do you have the package?

Yes

Product Description

What is the UPC number?

What should it scan at?

What were you charged?

Did you contact any person at that location?

Yes

What is their name(s)

or describe them

Documentation

One file only.
5 MB limit.
Allowed types: jpg, jpeg, png, pdf.

Additional Documentation

Maximum 5 files.
5 MB limit.
Allowed types: gif, jpg, jpeg, png, txt, rtf, pdf, doc, docx.

In filing this complaint, I understand that:

The Erie County Department of Public Advocacy, Bureau of Weights and Measures is not my private attorney but represents the public in enforcing laws designed to protect the public from misleading or unlawful business practices. My filing this complaint does not mean that the Erie County Department of Public Advocacy, Bureau of Weights and Measures has initiated a lawsuit or proceeding on my behalf or that it will do so.

The Erie County Department of Public Advocacy, Bureau of Weights and Measures cannot give me legal advice or represent me in court. If I have any questions concerning my legal rights or responsibilities, I should contact a private attorney.

In order to resolve my complaint, The Erie County Department of Public Advocacy, Bureau of Weights and Measures may send a copy of my complaint and any documents I provide to the person or business about whom I am complaining, and I authorize that person or business to release information concerning my complaint to the Erie County Department of Public Advocacy.

The Erie County Department of Public Advocacy, Bureau of Weights and Measures works with other state, local and federal government agencies to investigate complaints and coordinate law enforcement and may also share my complaint with them. In addition, The Erie County Department of Public Advocacy, Bureau of Weights and Measures may use information from my complaint in legal proceedings to establish violations of law.

Any false statement made in this complaint are punishable as crimes, including under Section 175 and/or Section 210 of the Penal Law.

I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.

Electronic Signature Agreement

By checking the "I agree" box below, you agree and acknowledge that 1) your form will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

I Agree

Date