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CITY OF DALLAS
ETHICS ADVISORY COMMISSION
COMPLAINT FORM
Please type or print legibly in blue or black ink.
NOTE: FILING A COMPLAINT THAT FALSELY ACCUSES SOMEONE OF A VIOLATION
OF THE ETHICS CODE MAY RESULT IN CRIMINAL PROSECUTION OR SANCTIONS OF
ANYONE WHO KNOWINGLY MAKES A FALSE ACCUSATION.
PART A – COMPLAINANT INFORMATION
1. Your full name (identifies you as the Complainant):
2. Your residence address (Street, City, State, and Zip Code):
3. Your business address (Street, City, State, and Zip Code):
4. Preferred telephone number:
Cell Home Business (circle one)
5. Alternate telephone number:
Cell Home Business (circle one)
6. Email address:
For Official Use Only
City of Dallas 1 of 5 Complaint Form
City Secretary’s Office Ethics Advisory Commission
REV 10/15
PART B – COMPLAINANT DECLARATION
I HAVE A COMPLAINT AGAINST:
1. Full name of person against whom you are bringing the allegation(s):
2. Check the box that applies to the person named above and fill in the applicable information:
Elected official
____________________________________
(office held)
Appointed official
____________________________________
____________________________________
(board/commission name)
(title/position held)
Candidate
____________________________________
(office sought)
City Employee
____________________________________
____________________________________
(title/position held)
(department)
3. Residence address (Street, City, State, and Zip Code) (If known):
4. Business address (Street, City, State, and Zip Code) (if known):
5. Telephone number (if known):
6. Email address (if known):
City of Dallas 2 of 5 Complaint Form
City Secretary’s Office Ethics Advisory Commission
REV 10/15
PART C – DESCRIPTION OF COMPLAINT
Provide a statement of the facts upon which your complaint is based. Describe the events in
the order in which they occurred. Keep dates of events in sequence. Include full names,
addresses, and phone numbers of all individuals involved, including any witnesses present
when the alleged violations took place. Be factual; the information you provide in this statement
must be based on facts and not on personal conjecture. Try to answer the questions “who,”
“what,” “where,” and “when.” Attach extra sheets if more space is needed.
PART D – CODE VIOLATIONS
List the specific sections and paragraphs of the Code of Ethics provisions you believe have
been violated. A copy of the Code of Ethics can be found on the city secretary’s website.
City of Dallas 3 of 5 Complaint Form
City Secretary’s Office Ethics Advisory Commission
REV 10/15
PART E – SOURCES OF EVIDENCE
Identify sources of evidence, if any, that you believe should be considered by the Ethics
Advisory Commission. Submit all information that you have; attach photocopies of any pertinent
papers or documentation to support your allegation.
Please note that if you submit evidence in
a format that the city secretary’s office cannot duplicate or display, the city secretary will request
that you provide the evidence in a format that the office can duplicate or display. If you fail to
provide the evidence to the city secretary’s office in a format that the office can duplicate or
display within seven days after the office has made a request, then the evidence may not be
presented to or considered by the ethics advisory commission or a panel of the commission.
City of Dallas 4 of 5 Complaint Form
City Secretary’s Office Ethics Advisory Commission
REV 10/15
I CERTIFY THAT I HAVE READ THIS COMPLAINT, I FULLY UNDERSTAND ITS
CONTENTS, AND I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF
THE STATE OF TEXAS THAT THE COMPLAINT STATES A VIOLATION OF CHAPTER 12A
OF THE DALLAS CITY CODE, THAT THIS COMPLAINT IS NOT BEING PRESENTED FOR
ANY IMPROPER PURPOSE, AND THE FOREGOING STATEMENTS AND EVIDENCE ARE
TRUE AND CORRECT OR, TO THE BEST OF MY KNOWLEDGE, ARE SUPPORTED BY
CREDIBLE EVIDENCE FORMED AFTER AN INQUIRY REASONABLE UNDER THE
CIRCUMSTANCES. I UNDERSTAND THAT A COPY OF THIS COMPLAINT WILL BE SENT
TO THE CHAIR OF THE ETHICS ADVISORY COMMISSION AND TO THE INDIVIDUAL
CHARGED IN THIS COMPLAINT. ALL PAPERS AND COMMUNICATIONS RELATING TO A
COMPLAINT MUST BE TREATED AS CONFIDENTIAL LAW UNLESS REQUIRED TO BE
MADE PUBLIC BY THE PUBLIC INFORMATION ACT (CHAPTER 552, TEXAS
GOVERNMENT CODE) OR OTHER APPLICABLE LAW.
_____________________________________
Signature
Before me the undersigned authority, on the _____ day of ___________, 20__, personally
appeared, ______________________________, known to me to be the person whose name is
subscribed hereto, and being duly sworn stated that such facts are true and correct, or, to the
best of his/her knowledge, formed after an inquiry reasonable under the circumstances, the
factual contentions are supported by credible evidence submitted in and with the complaint.
_____________________________________
Notary Public
<NOTARY SEAL> _________________________ County, Texas
My Commission expires:
_____________________________________
Special Note: Section 3.2 of the Ethics Advisory Commission Rules of Procedure states that
“supplements to a complaint may only be filed within seven days after the city secretary’s
acceptance of the original completed complaint.”
Should you have any questions concerning this form, please contact the City Secretary’s Office,
at (214) 670-3738 during regular business hours (8:15am – 5:15pm).
Upon completing ALL sections of this form, please hand deliver or send by certified mail with
any attachments to:
Office of the City Secretary
CITY HALL
1500 Marilla Street – Suite 5DS
Dallas, TX 75201
City of Dallas 5 of 5 Complaint Form
City Secretary’s Office Ethics Advisory Commission
REV 10/15
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Completed 14 February 2021

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