Fillable STATEMENT OF FACT AGAINST A COMMUNITY MANAGER (#514a) (Nevada Real Estate Division)

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STATEMENT OF FACT AGAINST A COMMUNITY MANAGER (#514a) (Nevada Real Estate Division)

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STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 West Sahara Avenue, Suite 325, Las Vegas, NV 89102
(702) 486-4480 * Toll free: (877) 829-9907 * Fax: (702) 486-4520
E-mail: CICOmbudsman@red.nv.gov http://www.red.nv.gov
Revised 05/18/18 Page | 1 514a
STATEMENT OF FACT
AGAINST A COMMUNITY MANAGER (#514a)
Statements 1 through 4 cited below must be met prior to filing this Statement of Fact. Please verify that you have met
the requirements by initialing in each box. As the aggrieved party, you:
1. Have sent the allegations of misconduct in writing to the Community Manager in an attempt to resolve the
issue before filing a complaint with the Division and provided proof of the written communication in the
form of an e-mail or letter. The written communication must include all allegations that you request the
Division to consider for possible investigation.
2. Have waited at least 12 working days for the Community Manager to acknowledge and respond in writing to
the alleged violation(s).
3. Have listed only one (1) alleged violation per page and have included applicable attachments (Exhibits)
behind each such page. You must provide all supporting documentation with the complaint.
4. If you are a tenant, you must have had the complaint approved (written communication) by the unit’s owner
without the use of a Power of Attorney.
Please indicate whether you have spoken to a staff representative from the Ombudsman’s Office to understand which
specific provision of NRS or NAC 116 may have been violated. Yes No If yes, name: __________________
Please Print or Type
Your Name: __________________________________________________________________________________
Your complete physical address: __________________________________________________________________
Unit Address, if different: ________________________________________________________________________
Email Address: ________________________________________________________________________________
Home Phone: Business Phone: ______________________________________
Name of Community Manager the complaint is against: ________________________________________________
Name of Management Company: __________________________________________________________________
Address of Management Company:
Management Company Telephone No. _______________________________________________________________
Name of the Association: __________________________________________________________________________
Legal action pending pertaining to the allegations filed? Yes No If so, what action?
Alternative Dispute Resolution (ADR) claim filed? Yes No If so, what date & claim#:
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 West Sahara Avenue, Suite 325, Las Vegas, NV 89102
(702) 486-4480 * Toll free: (877) 829-9907 * Fax: (702) 486-4520
E-mail: CICOmbudsman@red.nv.gov http://www.red.nv.gov
Revised 05/18/18 Page | 2 514a
Please complete the following information concerning your complaint. The Division’s ability to investigate the matter will depend
largely upon you providing a complete and detailed sworn statement. Attach all pertinent copies of papers and/or documents
relevant to the complaint to this form. It is advised that you retain a copy of this packet for yourself prior to submission.
You are required to (initial each box after completion):
State one (1) alleged violation, with a brief description, per page (reprint this page for each separate alleged violation).
Each allegation must include its own supporting documentation (Exhibit #1 for allegation #1, and so on), which must be
placed directly behind the allegation prior to submitting this package.
When completing the sections below, DO NOT write “See Attached.” If “See Attached” is written in the sections below
your complaint will not be processed.
Reviewed NAC 116A.350
prior to filing this complaint.
ALLEGED VIOLATION # : (To the point, state the alleged violation.)
SUPPORTING LAW AND/OR GOVERNING DOCUMENTS: (List the applicable laws and/or sections of governing documents.)
ATTACHMENTS: (List the types of documents marked as Exhibits, i.e., budget, notice of violation, governing document provisions,
etc. specific to the alleged violation cited above.)
CONSIDER THE FOLLOWING CAREFULLY
The Division is not empowered to compel anyone to accede to demands of any kind. We cannot force refunds of any kind. In
this regard, we suggest that you seek private counsel to protect your interests, as we are not authorized to give legal advice.
Do not delay any civil action you might be considering regarding this matter.
Should the Division determine that a case warrants opening against the Community Manager, an investigation will be initiated.
Considerable time may be required to complete our investigation. You will be advised of the disposition of this matter when the
investigation is completed. Also, it may be necessary for you to appear and testify should this matter proceed to a hearing before
the Commission for Common-Interest Communities.
I declare under penalty of perjury under law of the State of Nevada that the foregoing attached statement consisting
of ______ pages is true and correct.
Executed on
(Date) (Signature)
You can mail or hand-deliver the completed affidavit package to:
NEVADA REAL ESTATE DIVISION
OFFICE OF THE OMBUDSMAN
COMMON-INTEREST COMMUNITIES AND
CONDOMINIUM HOTELS PROGRAM
3300 W. SAHARA AVE., SUITE 350, LAS VEGAS, NEVADA 89102
Email and fax submissions will NOT be accepted
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STATEMENT OF FACT AGAINST A COMMUNITY MANAGER (514a) (Nevada Real Estate Division)

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Completed 28 December 2021

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