Name of Party Filing Complaint:

Address:

Telephone Number: (H) (W)

Date Complaint Form Completed:

Person who is Subject of Complaint:

Applicable Section of Garrett County Ethics Ordinance; (if known)

Brief Description of Substance of Complaint (Continue on back if necessary):

I HEREBY AFFIRM UNDER THE PENALTY OF PERJURY THAT THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF.

Signature

STATE OF MARYLAND, COUNTY OF , TO WIT:

I HEREBY CERTIFY that on this day of , before me, the subscriber, a Notary Public in and for the State and County aforesaid, personally appeared
sign the attached Complaint.

AS WITNESS my hand and Notarial Seal.

Notary Public

My Commission expires: