"Complaint Form - Weights and Measures" - Mississippi

Complaint Form - Weights and Measures is a legal document that was released by the Mississippi Department of Agriculture and Commerce - a government authority operating within Mississippi.

Form Details:

  • Released on January 1, 2012;
  • The latest edition currently provided by the Mississippi Department of Agriculture and Commerce;
  • 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 fillable version of the form by clicking the link below or browse more documents and templates provided by the Mississippi Department of Agriculture and Commerce.

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Mississippi Department of Agriculture and Commerce
Weights and Measures Division
P. O. Box 1609, Jackson, MS 39215-1609
Office: 601-359-1149
Fax: 601-359-1175
COMPLAINT FORM
Date of Complaint: ________________ Inspector Assigned: _________________
Consumer Name:
Address:
City:
State:
Zip:
County:
Telephone Number:
Fax Number:
Email Address:
Complaint/Concern submitted against:
Business Name:
Date Occurred:
Address:
Business Contact Name:
City:
State:
Zip:
County:
Telephone Number:
Fax Number:
Email Address:
Nature of Complaint
Please check which best describes the nature of the complaint and provide the details.
1) Product Weighed ___________Total Weight ____Weight Deduction
_____Scale Zeroed ______
(tires, motor)
2) Did you get a printed weight ticket? Y______
N _______
3) Was there a Remote Display? Y____ N____ Did you see actual weight? Y_____ N_____
4) Was weight in question; In Bound (IB) or Out Bound (OB)? IB______ OB ______Was customer in or out
of truck while weighing? In truck_______ Out of truck _______
5) Did you ask for reweigh? Y______ N _______
Details of Complaint:
Resolution of Complaint:
Form 1/2012
Mississippi Department of Agriculture and Commerce
Weights and Measures Division
P. O. Box 1609, Jackson, MS 39215-1609
Office: 601-359-1149
Fax: 601-359-1175
COMPLAINT FORM
Date of Complaint: ________________ Inspector Assigned: _________________
Consumer Name:
Address:
City:
State:
Zip:
County:
Telephone Number:
Fax Number:
Email Address:
Complaint/Concern submitted against:
Business Name:
Date Occurred:
Address:
Business Contact Name:
City:
State:
Zip:
County:
Telephone Number:
Fax Number:
Email Address:
Nature of Complaint
Please check which best describes the nature of the complaint and provide the details.
1) Product Weighed ___________Total Weight ____Weight Deduction
_____Scale Zeroed ______
(tires, motor)
2) Did you get a printed weight ticket? Y______
N _______
3) Was there a Remote Display? Y____ N____ Did you see actual weight? Y_____ N_____
4) Was weight in question; In Bound (IB) or Out Bound (OB)? IB______ OB ______Was customer in or out
of truck while weighing? In truck_______ Out of truck _______
5) Did you ask for reweigh? Y______ N _______
Details of Complaint:
Resolution of Complaint:
Form 1/2012