**Andrew Bailey**
Missouri Attorney General

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Report Unauthorized Alien Workers

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If you have information that a business entity is violating the law by employing an unauthorized alien and is receiving a state administered tax credit, abatement, or loan, or has been awarded a state grant or contract exceeding $5,000, please complete this form.

Report Unauthorized Alien Workers

YOUR CONTACT INFORMATION

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

County

Primary Phone Number(Required)

Email(Required)

Please select one box:(Required)

I am a state official.

I am a state resident.

I am the registered agent, corporate officer or legal representative of a business entity.

Business Information

Business Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County

Business Phone Number

Website

Name of Owner or Principal

Type of Business

Complaint Information

A valid complaint cannot allege a violation solely or primarily on the basis of national origin, ethnicity or race.

Describe in detail the information that indicates the business employs unauthorized aliens.(Required)

When did the business employ unauthorized aliens?(Required)

Where did the business employ unauthorized aliens?

What state administered tax credit, abatement or loan is being received by the business?

Section 285.530 of the Revised Statutes of Missouri prohibits businesses entities or employers who receive state administered tax credits, abatements or loans, as well as those awarded contracts or grants from the State of Missouri in excess of $5000, from knowingly employing, hiring for employment, or continuing to employ an unauthorized alien to perform work in Missouri. Section 285.535 allows any state official, business entity or state resident to file a complaint regarding the employment of unauthorized aliens. Providing false information in this affidavit can result in civil and/or criminal penalties. I DECLARE UNDER PENALTY OF PERJURY under the laws of the State of Missouri that the foregoing is true and correct to the best of my knowledge and belief. If signing for a business entity in a representative capacity, I acknowledge that I am Authorized to sign this application on behalf of the complainant.

Name

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