Draft Version 09/06/2018
Your Name
Contact Information (Please provide a minimum of one means of contact, i.e. email, phone, or mailing address)
Mailing Address
Date of Alleged Violation: (or date you became aware of allegation/s).
Type of Allegation(s): Check the appropriate box below to indicate which set of laws you believe were violated by the Respondents.
Witness Information. Provide the name, and as many points of contact as possible (email and/or telephone number) of each person you believe may have information that would assist the Commission in its evaluation of this complaint. Also, provide a brief summary of the information that you believe each of the persons listed can provide to support the allegations stated in this complaint (use additional pages if necessary).
Witness 1:
Name
Witness 2:
Witness 3:
Documentation. Please attach copies of any documents in your possession that relate to the allegations stated in this complaint. In addition, state below whether or there are other records not in your possesion that you believe, may assist the commission in its evaluation of your complaint.
Upload File(s)
Related Complaints. Have you made the same or similar allegations to another agency?
VERIFICATION:
Date Executed