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Perry Kellam EX-1111 9682-2021

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Suzanne Hook EX-1110 9272-2020

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Harry Stetson EX-1109 9483-2020

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Sherry Smith EX-1108 9256-2020

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Ashley Mejia EX-1107 9550-2020

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Jameila Mack EX-1106 9408-2020

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Felicia Williams EX-1101 9549-2020

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PENNSYLVANIA
GAMING CONTROL BOARD

PA Gaming Control Board
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Harrisburg, PA 17101
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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:
EMAIL ADDRESS:
DATE AND APPROX TIME OF INCIDENT:
COMPLAINT TYPE:
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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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ATTACHMENTS or DOCUMENTATION?
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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