Securities Complaint

THIS FORM IS ONLY FOR THOSE FILING A NOTICE PURSUANT TO MO. REV. STAT. §§ 409.600 – 409.630.  PLEASE MAKE ALL OTHER COMPLAINTS AT THE FOLLOWING LINK: Complaint Form 

 Notification Pursuant to the Senior Savings Protection Act

(Mo. Rev. Stat. 409.600, et seq.)

Directions

Please complete the following questions with as much detail as possible. This allows our staff to gather and analyze the most pertinent information in assessing this notification and a possible enforcement action.

Filer/Reporter Information
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Type of Notice
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Qualified Individual Refusing Request for a Disbursement
Broker-Dealer Agent Information

Qualified Adult (Suspected Victim)
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Person Suspected to have Engaged in the Financial Exploitation
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Refusal of the Requested Disbursement (Financial Transaction)

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Other : (8000 characters allowed)    
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Please be advised that the Missouri Securities Division, and the Department of Health and Senior Services are prohibited by law from giving you legal advice, legal opinions, or acting as your attorney.  Therefore, you may wish to consult with a private attorney to discuss your legal rights and remedies.

If you have any questions about this form, please call the Missouri Securities Division investor hotline at 1-800-721-7996 and/or the Department of Health and Senior Services Adult Abuse and Neglect Hotline at 1-800-392-0210.

Please mail all correspondence to:
Office of the Secretary of State
Securities Division
PO Box 1276
600 W. Main St.
Jefferson City, MO 65102
Please e-mail hlstate@health.mo.gov for co-investigation as necessary.

Digital Signature 

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*I agree that the information provided is accurate to the best of my knowledge and wish to provide a Digital Signature to my complaint.