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Title II Discrimination Complaint Form <br />Has the complaint been filed with another bureau of the Department of Justice or any other <br />Federal, State, or local civil rights agency or court? <br />Yes No <br />If yes: <br />Agency or Court: <br />Contact Person: <br />Address: <br />City, State, and Zip Code: <br />Telephone Number: <br />Date Filed: <br />Do you intend to file with another agency or court? <br />Yes No <br />Agency or Court: <br />Address: <br />Page 3 of 4 <br />