"Consumer Complaint Form" - Texas

Consumer Complaint Form is a legal document that was released by the Texas Funeral Service Commission - a government authority operating within Texas.

Form Details:

  • The latest edition currently provided by the Texas Funeral Service Commission;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Texas Funeral Service Commission.

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Texas Funeral Service Commission
Complaint Form Instructions
Please read the following instructions prior to completing the complaint form.
COMPLAINT FORM
PERSON REGISTERING COMPLAINT: Please type or legibly print your name, address,
phone number(s) and email address.
COMPLAINT REGISTERED AGAINST: Please type or legibly print the name, address,
name of business and phone numbers of the person or establishment whom you are filing the
complaint against. If you are filing a complaint against more than one individual, please list the
names, addresses and phone numbers on a separate sheet.
SUPPORTING DOCUMENTATION: Supporting documentation allows the Commission to
fully investigate your complaint.
Please enclose copies of documents which support the
complaint. Do not include original documents as all documents submitted become the property
of the Commission and cannot be returned. Additional documents may be requested.
DETAILS OF COMPLAINT: State in simple, narrative language why you think the
establishment/person violated funeral service laws. You do not need to cite a specific law or
agency law. Please be as specific as possible when providing dates, places, or additional details.
Your complaint should include “who, what, when, where, why and how.” You may attach
additional pages if necessary. Please number and initial all pages of your narrative in the lower
right hand corner.
MAILING INSTRUCTIONS
Please keep a copy of your completed COMPLAINT FORM and the originals of any
documentation included.
Mail your completed form to:
Texas Funeral Service Commission
333 Guadalupe Street, Suite 2-110
Austin, Texas 78701
CONCURRENT JURISDICTION
Along with the TFSC, the Texas Department of Banking (TDB) and the Texas Department of
Insurance (TDI) have jurisdiction over the death care industry. TDB regulates the trust funded
prepaid funeral industry and perpetual care cemeteries. TDI regulates insurance and annuity
contracts that fund prepaid contracts.
When a complaint is received by the TFSC, it is reviewed to determine which agency has
jurisdiction and forwarded to the appropriate agency for enforcement if necessary.
Texas Funeral Service Commission
Complaint Form Instructions
Please read the following instructions prior to completing the complaint form.
COMPLAINT FORM
PERSON REGISTERING COMPLAINT: Please type or legibly print your name, address,
phone number(s) and email address.
COMPLAINT REGISTERED AGAINST: Please type or legibly print the name, address,
name of business and phone numbers of the person or establishment whom you are filing the
complaint against. If you are filing a complaint against more than one individual, please list the
names, addresses and phone numbers on a separate sheet.
SUPPORTING DOCUMENTATION: Supporting documentation allows the Commission to
fully investigate your complaint.
Please enclose copies of documents which support the
complaint. Do not include original documents as all documents submitted become the property
of the Commission and cannot be returned. Additional documents may be requested.
DETAILS OF COMPLAINT: State in simple, narrative language why you think the
establishment/person violated funeral service laws. You do not need to cite a specific law or
agency law. Please be as specific as possible when providing dates, places, or additional details.
Your complaint should include “who, what, when, where, why and how.” You may attach
additional pages if necessary. Please number and initial all pages of your narrative in the lower
right hand corner.
MAILING INSTRUCTIONS
Please keep a copy of your completed COMPLAINT FORM and the originals of any
documentation included.
Mail your completed form to:
Texas Funeral Service Commission
333 Guadalupe Street, Suite 2-110
Austin, Texas 78701
CONCURRENT JURISDICTION
Along with the TFSC, the Texas Department of Banking (TDB) and the Texas Department of
Insurance (TDI) have jurisdiction over the death care industry. TDB regulates the trust funded
prepaid funeral industry and perpetual care cemeteries. TDI regulates insurance and annuity
contracts that fund prepaid contracts.
When a complaint is received by the TFSC, it is reviewed to determine which agency has
jurisdiction and forwarded to the appropriate agency for enforcement if necessary.
TEXAS FUNERAL SERVICE COMMISSION
CONSUMER COMPLAINT FORM
Please provide as much of the information requested as possible. You may attach additional
pages as necessary.
Copies of any photographs, letters, contracts, or other documents
pertinent to your complaint should also be enclosed.
Please Type or Print Clearly
Person Registering Complaint
Name ________________________________________________________________________
Address_______________________________________________________________________
City, State Zip _________________________________________________________________
Home Phone ___________________________ Cell Phone ____________________________
Email Address _________________________________________________________________
Complaint Registered Against
Establishment __________________________________________________________________
Individual _____________________________________________________________________
Business Address _______________________________________________________________
City. State Zip _________________________________________________________________
Business Phone __________________________ Other Phone____________________________
Allegations and Comments
Date(s) Problem/Transaction Occurred ______________________________________________
______________________________________________________________________________
Please describe your complaint in detail (attach additional sheets if necessary).
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Have you discussed your complaint with the establishment? Yes
No
If yes, when?
______________________________________________________________________________
What was the response? __________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Have you filed your complaint with any other state agency or a law enforcement agency or have
you consulted with an attorney? Yes
No
If yes, what agency or attorney?____________________________________________________
What action did agency or attorney take? Include case number, if applicable.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please list the names, addresses and telephone numbers of any witnesses to the alleged act(s):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
To the best of my knowledge, the above statements are true and correct.
Signature:
Date:
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