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Section IV Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State court? ☐ Yes ☐ No If yes, check all that apply: ☐ Federal Agency: ☐ Federal Court: ☐ State Agency: ☐ State Court: ☐ Local Agency: Provide information for the contact person at the agency/court where the complaint was filed. Name and Title: Agency: Address: Telephone: You may attach any written materials or other information that you think is relevant to your complaint. Signature and date required below. _____________________________________ ________________________ Signature Date Please submit this form by mail, email or in person to the address below. Erie County Division of Equal Employment Opportunity Title VI/ADA Coordinator 95 Franklin St, Room 931 Buffalo, NY 14202 [email protected] This complaint may also be filed directly with the New York State Department of Transportation, Office of Civil Rights, 50 Wolf Road, 6th Floor, Albany, NY 12232, (518) 457-1129 Fax (518) 549-1273, [email protected] or the Federal Transit Administration, Office of Civil Rights, Attention: Title VI Program Coordinator, East Building, 5th Floor-TCR, 1200 New Jersey Ave., SE Washington, DC, 20590. 88 | P a g e - E r i e C o u n t y G o i n g P l a c e s P o l i c y a n d P r o c e d u r e