Fillable WASHINGTON COUNTY ETHICS COMMISSION c/o Office of the (Washington County Maryland)

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WASHINGTON COUNTY ETHICS COMMISSION c/o Office of the (Washington County Maryland)

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1
WASHINGTON COUNTY ETHICS COMMISSION
c/o Office of the County Attorney
Washington County Administration Building
100 W. Washington Street, Suite 1101
Hagerstown, Maryland 21740
ETHICS COMPLAINT FORM
Instructions:
• Please type or print the information requested.
• Use of this form is not mandatory, but all of the information requested below should be
provided when a complaint is made.
• Anonymous complaints are not accepted.
• The Ethics Commission only has the jurisdiction to consider violations of the specific
provisions of the Ethics Ordinance. General allegations that conduct is “unethical”
cannot be considered unless the conduct would constitute a violation of the Ordinance
itself.
Information about the Complainant:
Name of person making the complaint: _________________________________________________
Address: ____________________________________________________________________________
Email address: _______________________________________________________________________
Telephone number(s):
Home: _____________________
Cell: _____________________
Work: _____________________
Preferred method of communication: ___________________________________________________
2
Information about the complaint:
Provide the specific provision of the Ethics Ordinance that you believe has been violated:
_______________________________________________________________________________
_______________________________________________________________________________
Name of official or employee who is the subject of the complaint: __________________________
Describe the facts and circumstances that support the complaint. (Provide as much detail as
possible. Attach additional pages if necessary.)
Attach any relevant records in your possession or control that you want the Ethics Commission
to consider in reviewing your complaint.
3
Witnesses:
Identify any witnesses who have personal knowledge of the facts and circumstances related to
the complaint:
1. Name: __________________________________________________________
Address: __________________________________________________________
Email address: __________________________________________________________
Telephone number(s): ______________________________________________________
Relevant information:
2: Name: ___________________________________________________________
Address: ___________________________________________________________
Email address: ___________________________________________________________
Telephone number(s): ______________________________________________________
Relevant information:
3. Name: ___________________________________________________________
Address: ___________________________________________________________
Email address: ___________________________________________________________
Telephone number(s): ______________________________________________________
Relevant Information:
4
I hereby affirm under the penalty of perjury that the contents of this complaint, including any
attachments, are true and correct to the best of my knowledge, information and belief.
_________________________________ ________________________________
Complainant’s Signature Date
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WASHINGTON COUNTY ETHICS COMMISSION co Office of the (Washington County Maryland)

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Completed 30 June 2021

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