My Safe Florida Home
Fraud Complaint Form
(Formulario de
Reclamaciones)

    Please provide additional documentation to support your complaint (PDF document - 8MB Limit)
    (Proporcione documentación adicional para respaldar su reclamacion)

    The completion and submission of this My Safe FL Home Complaint Form is subject to section 837.06, Florida Statutes, False Official Statements of the Florida Statutes which states in relevant part:

    Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes.

    I have carefully read and fully understand that any false statement made on this My Safe FL Home Complaint Form with the intent to mislead a public servant in the performance of his or her official duty can be found guilty of a Misdemeanor in the Second Degree pursuant to section 837.06, 775.082, and 775.083, Florida Statutes.

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