FWA Complaint Form

COMPLAINANT INFORMATION

If you wish to remain anonymous, do not enter your name but please provide contact information such as an e-mail or telephone number

Do you wish to remain anonymous?

Yes (I understand that if I remain anonymous, I am not eligible for whistle-blower status.)

Full Name

Phone Number

Home Address

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

Work Address

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

Please select which best applies to your status

Private Citizen

Current Employee of

St. Johns County Government

St. Johns County Clerk of the Circuit Court and County Comptroller

St. Johns County Contractor

Former Employee of

St. Johns County Government

St. Johns County Clerk of the Circuit Court and County Comptroller

St. Johns County Contractor

Employee Applicant of

St. Johns County Government

St. Johns County Clerk of the Circuit Court and County Comptroller

Has this issue been reported to any other party?

Yes

If Yes, Whom? When did you contact this person/entity and what were the results?

INFORMATION ABOUT THE EMPLOYEE, VENDOR, OR INDIVIDUAL WHO IS THE SUBJECT OF THIS COMPLAINT

Name

First Last

Phone

Address (if known)

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

Work Address

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

Department/Division

Title

Nature of allegation(s)

Fraud
“Fraud” means to obtain something of value through willful misrepresentation, including, but not limited to, intentional misstatements or intentional omissions of amounts or disclosures in financial statements to deceive users of financial statements, theft of an entity’s assets, bribery, or the use of one’s position for personal enrichment through the deliberate misuse or misapplication of an organization’s resources. See F. S. 11.45(1)(e)

Waste
“Waste” means the act of using or expending resources unreasonably, carelessly, extravagantly, or for no useful purpose. See F. S. 11.45(1)(m)

Abuse
“Abuse” means behavior that is deficient or improper when compared with behavior that a prudent person would consider a reasonable and necessary operational practice given the facts and circumstances. The term includes the misuse of authority or position for personal gain. See F. S. 11.45(1)(a)

SUMMARY OF COMPLAINT

Please be as specific as possible. Give the name(s) of the employee(s) or vendor who committed a wrongdoing such as fraud, waste, or mismanagement of County/COCC funds or resources. State exactly what happened. Provide witness' names and how to contact the individual(s), if known. Provide the details and location of any records or documents that may support your complaint.

Identify witnesses, including name, phone number, e-mail, and title

Identify any records you have that support the allegation(s)

CAPTCHA

BRANDON J. PATTY

Clerk of the Circuit Court and County Comptroller

St. Johns County, Florida

COMPLAINANT INFORMATION

Brandon J. Patty

Clerk of the Circuit Court and County Comptroller

St. Johns County, Florida

Richard O. Watson Judicial Center

4010 Lewis Speedway

St. Augustine, FL 32084

Phone:

(904) 819-3600

Hours of Operation:

Mon. - Fri. 8:00 AM to 5:00 PM