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Information About the Fraud
Type of Fraud
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Farm
Liability
Other
Where did the suspected fraud take place?
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Washington, D.C.
Deleware
Florida
Georgia
Hawaii
Idaho
Illiniois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
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Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
When did the suspected fraud take place?
Date
Time
Name(s), address(es), phone number(s) and other information about individuals involved
How did you learn about the suspected fraud? Please describe the incident in detail.
Additional information pertaining to the suspected fraud
Information About You (Optional)
We can assure you that your identity will remain anonymous should you choose to share it.
May we please contact you?
Yes
No
Please provide at least your first name and either your phone number or your email address.
First Name
Last Name
Phone Number
Email Address
