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On) A consumer, or any representative, acting on behalf of any consumer or consumers, may file a W&I Code Section 4731 complaint against a regional center, developmental center, or any private service provider receiving Lanterman Act funds. This form is voluntary and may be used as guidance in writing your complaint letter. Name of Person filing Complaint Relationship to Consumer Address (Mailing Address) Name of Consumer (City) Telephone Number (State) (Zip) Birth Date (Month, Date, Ye.

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