Fraud Award Program Nomination Form

PO Box 2201

Bothell, WA  980041-2201

(425) 806-6530
 

Please read the Award Program Rules before completing this form.
 

The following information is vital to providing the Puget Sound Special Investigator Board with a complete understanding of each case and helps the Award Committee base its award determination.  Questions should be answered by the Nominator.

 

  1. HISTORY OF ACCUSED.  Does the accused have a record of prior fraud crime attempts or convictions?  Other crimes?  If yes, please provide details.

  1. CIRCUMSTANCES.  How did the nominee come to be involved with your agency?  Was he or she aware of the award program before coming to you with the information.  If yes, please provide details.

  1.  RISK.  Did the Nominee place himself or herself in personal danger by coming to authorities and cooperating in the case?

  1. NATURE OF FRAUD.  Was the fraud connected to another crime?  Were lives endangered? Please give as many details as possible.

  1.   OTHER INFORMATION.  Please supply any other information you find appropriate.

  1. SUPPORTING MATERIALS.  If you have supporting material, please print this form, and mail it along with your supporting material to the address above.  If not, you may complete this form on line and submit it electronically.

   

 

 

Please review the above information before completing.  If it is necessary to conceal the identity of the nominee, please assign a CI number in the space below.

 

 

 

 

 

(Complete only if conviction involved)

 

 

 

 

 

Click "Submit" to enter your nomination

or you may print the nomination and mail it to:

 

Puget Sound Special Investigators

P O Box 2201

Bothell, WA  98011