Fillable SWORN COMPLAINT AND AFFIDAVIT The full name of (Lexington-Fayette Urban County Government)

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SWORN COMPLAINT AND AFFIDAVIT The full name of (Lexington-Fayette Urban County Government)

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BROWSE LEXINGTON-FAYETTE URBAN COUNTY GOVERNMENT (KY) FORMS

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Page 1
SWORN COMPLAINT
AND AFFIDAVIT
Pursuant to Ethics Act Section 25-23
The full name of the person(s) or legal entity filing the Complaint (hereinafter called the
“Complainant”) is .
If the Complainant is a legal entity, it is: a corporation ; a partnership ; or
. Check one of the boxes or write in the type of legal entity.
The Complainant’s address is .
(Mailing or Street Address including Zip Code)
THE COMPLAINT IS AS FOLLOWS:
I. NAME, TITLE, AND ADDRESS OF RESPONDENT
The person who is the subject of the Complaint (hereinafter called the “Respondent”)
is currently
(Name of Respondent(s))
.
(Position or Job Title of each Respondent)
The Respondent’s address is .
(Mailing or Street Address including Zip Code)
R
eturn to:
Council Clerk’s Office
LFUCG
200 E. Main Street, 2
nd
floor
Lexington, KY 40507
Page 2
II. NATURE OF VIOLATION
If possible, state the ordinance violated.
If more space is needed, attach a sheet immediately after this page
and label it as “Page 2(a)”.
Page 3
III. STATEMENT OF FACTS
State the facts and dates or period(s) of time in support of allegations.
Please be simple, concise and direct
.
If more space is needed, attach a sheet immediately after this page
and label it “Page 3(a)”.
Page 4
IV. LISTING OF DOCUMENTS AND OTHER MATERIALS
List or attach, if possible, any documents or portions of documents which relate to the allegations.
If more space is needed, attach a sheet immediately after this page
and label it “Page 4(a
)”.
DO YOU WAIVE THE CONFIDENTIALITY OF THE EXISTENCE
OF ANY PRELIMINARY INQUIRY CONCERNING THIS
COMPLAINT?
YES NO
Page 5
AFFIDAVIT
NOTICE: IF THERE ARE MULTIPLE COMPLAINANTS, COMPLETED COPIES
OF THIS PAGE MUST BE SUBMITTED FOR EACH COMPLAINANT.
COMMONWEALTH OF KENTUCKY
COUNTY OF FAYETTE
COMES NOW, (Complainant),
and being duly sworn, deposes and states as follows: I, being the heretofore
named Complainant or an authorized representative of the same, do swear or
affirm, under penalty of perjury, that I have knowledge of the facts alleged
hereinabove and the information contained herein is true and correct.
Signature of Complainant
Subscribed and sworn to before me this day of , 20 .
My commission expires .
NOTARY PUBLIC
Return to:
Council Clerk’s Office
LFUCG
200 E. Main Street, 2
nd
floor
Lexington, KY 40507
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SWORN COMPLAINT AND AFFIDAVIT The full name of (Lexington-Fayette Urban County Government)

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Completed 3 August 2020

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