Complaint sample. PDF. Complaint fill in. PDF.Field 1: Fill in the county in which the action is brought. Be consistent with other forms. This form is a sample complaint under the New York Consolidated Laws, Civil Practice Law and Rules (CPLR). Printable Complaint Form. Send verified complaint new york sample via email, link, or fax. You can also download it, export it or print it out. The ACS is a sample survey sent to 3.5 million households annually, rather than a complete enumeration of every household in the United States. To start the process of reporting discrimination, please call 311 or (212) 416-0197 and ask for the NYC Commission on Human Rights or send us an inquiry.