IC3 Complaint Referral Form

Please review your complaint for accuracy, prior to submitting it to the IC3.

The following information was provided by the victim and may be forwarded to the
appropriate law enforcement or regulatory agencies.

Your Personal Information* First Name:Deputy
Middle Name:Chief
* Last Name:Kimerer
Business Name:Seatlle Police Department
* Age:40 - 49
* Gender:M
* Address:610 Fifth Avenue,
Address (continued):P.O. Box 34986
Suite/Apt./Mail Stop:
* City:Seattle
Do you live within the city limits?:

Yes

No
County:USA
State:Washington
* Country:United States
* Zip Code / Route:98124
* Phone Number:2066847664
* E-mail Address:secseminar2007@yahoo.com

Name of your local police or sheriff's office:
[ no response provided ]

Is the complaint you are filing related to the Internet or an online service?
Yes No

Do you have pertinent documents in paper form?
Yes No

Information about the Individual/Business that victimized youBusiness Name:
First Name:
Middle Name:
Last Name:
Gender:U
Address:
Address (continued):
Suite/Apt./Mail Stop:
City:
State:
Country:
Zip Code / Route:
Phone Number:
E-mail Address:

Other IdentifiersWeb Site:
IP Address:
IRC Server:
Chat Room Name:
Usenet Newsgroup:
Other:

Monetary Loss

*Please specify the total dollar amount of your loss from this incident:
$ 0 (US Dollars)

Please indicate the means of payment (select all that apply)
Cash
Cashier's Check
Check/Debit Card
Credit Card
Money Order
Wire Transfer
Other (Specify Other)

Did you use a third party online payment service such as PayPal, BidPay, Escrow?
Yes No

Description of the Incident*Describe in your own words how you have been victimized.
Be specific. Include date(s) of transaction(s), a description of any items that were not delivered or were counterfeited, any transaction numbers (from Ebay, Western Union, PayPal, etc.), and any other pertinent information that helps to explain how you were victimized. Also if you received anything by U.S. Mail, FedEx, or UPS, specifically describe the envelope, by the date, time, city and zip code shown on the stamp cancellation postmark.

I am on the Board of Directors of the Downtown Emergency Service center an organization of low lifes and screw ups who are engaged in computer hacking from the Connection as explained in more detail http://www.geocities.com/secseminar2007/wa/index.html Downtown Emergency Service Center 515 Third Avenue Seattle, WA 98104 (USA) (206) 464-1570 FAX: 624-4196

Please indicate any medium used by the individual/business in the course of the incident.
Bulletin board
Chat room
Email
Fax
In person
Internet messaging
Mail
Newsgroup
Telephone
Web site
Wire
Other

Please indicate the initial means of contact with the individual/business that victimized you.
Other

Was this initial means of contact unsolicited/uninvited?
Yes No

What was your relationship with the individual/business you are complaining about prior to the incident you are reporting?
business acquaintance

Did you conduct any research on the individual/business prior to the incident?
Yes No

How much time has passed since you determined you were victimized?
Less than 1 week

Contact Information

Are there witnesses or other victims to this crime?
I am on the Board of Directors of the Downtown Emergency Service center an organization of low lifes and screw ups who are engaged in computer hacking from the Connection as explained in more detail http://www.geocities.com/secseminar2007/wa/index.html Downtown Emergency Service Center 515 Third Avenue Seattle, WA 98104 (USA) (206) 464-1570 FAX: 624-4196

Have you reported this crime to any law enforcement or government agencies?
Better Business Bureau
Consumer protection agency
Individual/business that victimized you
Police/other law enforcement
Private attorney

Provide the specific name of each organization, contact name, contact phone number, email address, date reported, and report number (if known).
Online report filed with Seattle Police Department

Complaint Referral Form

Internet Crime Complaint Center