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Maria Hernandez-Salinas EX-1243 10509-2022

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Edwin Taylor EX-1244 10534-2022

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Philip Aye EX-1223 10479-2022

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PENNSYLVANIA
GAMING CONTROL BOARD

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EMPLOYEE WEB EMAIL | REPORT A WEBSITE ISSUE

PRIVACY POLICY | Copyright © 2024 - PENNSYLVANIA GAMING CONTROL BOARD SITE BY ACUTA DIGITAL
NAME OF INDIVIDUAL FILING A DISPUTE OR COMPLAINT

First Name

LAST NAME:
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HOME ADDRESS:
Home Address
PHONE NUMBER:
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DATE AND APPROX TIME OF INCIDENT:
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ONLINE SITE USED:
DEVICE TYPE:
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Please provide a summary of the incident or dispute to the best of your knowledge. Include any statements which you made to the licensed gaming entity's personnel or any statements you made to witnesses to the incident or dispute.
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While NOT REQUIRED to file a complaint, after completing this form, if you have items (texts, screen shots, emails, etc.) relating to this complaint, you can send them in a separate email. For instructions, please reference the confirmation email that will be sent you once this form is submitted
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