JUNE 2017
FOR OFFICIAL USE ONLY
Send completed form to:
CASE NUMBER:
No. Year
______ _______
Chairman
Town of Leonardtown
Ethics Commission
PO Box 1
Leonardtown, MD 20650
COMPLAINT /
ADVISORY OPINION
INSTRUCTIONS Please see Page 2 of this form
1. Identify the person you are complaining about (herein referred to as "Respondent").
Name:
Position or Title with The
Town of Leonardtown:
Work Phone Number
(if known):
Department or
Agency of Town
Of Leonardtown
: (If applicable)
2. Explain in detail why you believe that the individual named above may have violated the Code of Ethics and/or Code of Conduct. Attach an extra sheet
of paper if necessary. Fill in the box below.
3. Attach or make reference to any documents, materials, minutes, resolutions or other evidence which support your allegations. Any written witness
statement should be sworn to or affirmed under penalty of perjury. List all attachments by name and date of document and number of pages of
document; then cite specific portion of document that supports your allegation.
4. Sworn to and subscribed before me this
I swear or affirm, under penalty of perjury, that the facts set forth in this
complaint are true and correct to the best of my knowledge and belief. I also
swear and affirm that I have read and understand the confidentiality
requirements as set forth on page 2 of this form and will abide by said
confidentiality requirements.
day of
, 20
Notary Public Signature of Complainant
My Commission Expires:
Print or Type
Your Name:
Work Phone No.:
Address:
Home Phone No.:
JUNE 2017
INSTRUCTIONS
1. Complete all sections of the complaint/advisory opinion form. Incomplete forms will not be processed.
2. Give the specific name and position or title of the person about whom you are complaining. If you are complaining about more than one
person, use a separate complaint form for each person.
3. Provide a detailed account of the activity that is alleged to be in violation of the Code of Ethics of the Town of Leonardtown. The
Commission's jurisdiction extends solely to alleged violations of the Codes of Ethics. Please insure that all allegations relate to specific
individuals. If you are not sure that the Commission has jurisdiction over the conduct or individual in question, refer to the Code of Ethics.
This document is available in the Town Office and online at www.leonardtown.somd.com under Ethics Commission or refer to the
Municipal E-Code link to Chapter 9: Code of Ethics.
4. Enclose or refer in detail to specific portions of records, documents, minutes, etc. that support your allegations. Please note that this
complaint and all documents you submit in support will be provided to Respondent. Respondent may then make the complaint public.
5. Sign the form and have a notary sign, date, and note the date his/her Commission expires, or have a lawyer licensed in MD take your
acknowledgement.
6. The Ethics Commission meets quarterly and will review and deliberate your complaint/advisory opinion at the next scheduled meeting.
7. Be sure to keep the Ethics Commission informed in writing of any changes to your mailing address and other contact information. Failure
to do so may jeopardize the prosecution of your Complaint.
IMPORTANT
Any person filing a complaint with the Town of Leonardtown Ethics Commission should be aware of all of the provisions of Chapter 9
of the Code of Ethics and the Town of Leonardtown Ordinance No. 156. See 3 above for resource.
Good Faith Disclosures
No person shall take or threaten to take official action against an individual for such individual's disclosure of information to the Commission.
After receipt of information from an individual the Commission shall not disclose the identity of such individual without such individual's consent
unless the Commission determines that such disclosure is unavoidable during the course of its investigation. No person shall be subject to civil
liability for any good faith disclosure that such person makes to the Commission.
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