Suspected Welfare Fraud Report Form
Please provide as much infomation as you can about the welfare recipient that is committing fraud.
Welfare Recipient's Name:
Welfare Recipient's Address:	Street, City, Zip Code
Date of Birth or Approximate Age:
Children Living in the Home:
Explain the Complaint:
The following information is optional.  You may choose to remain anonymous; however giving us your contact information will allow us to contact you if more information is needed.
Your Name:
Your Address:
Your Phone Number:
Additional Comments: