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Complaint Pursuant to the
Procurement Lobbying Act

If you are unable to fill out and submit this form electronically, please send all the requested information to:

NYS DEPARTMENT OF PUBLIC SERVICE
Ms. Kathleen Burgess, Assistant Counsel and
Department Ethics Officer
3 EMPIRE STATE PLAZA
ALBANY, NY 12223-1350




* Indicates required information

Procurement Number: *
Full Name : *
Daytime Reach Number: *
Email Address: *
Organization:
Street Address: *
City: *
State: *
Zip Code: *
* Please describe the violation:



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