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Sworn Complaint - Texas
| Sworn Complaint Form. This is a Texas form and can be used in Ethics Commission Statewide . |
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Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) SWORN COMPLAINT BEFORE THE TEXAS ETHICS COMMISSION An individual must be a resident of the state of Texas to be eligible to file a sworn complaint with the Texas Ethics Commission. The complainant is required to attach to the complaint a copy of one of the following documents: · complainant's driver's license or personal identification certificate issued under Chapter 521 of the Transportation Code, or commercial driver's license issued under Chapter 522 of the Transportation Code; or · a utility bill, bank statement, government check, paycheck or other government document that shows the name and address of the complainant and is dated not more than 30 days before the date on which the complaint is filed. Effective September 1, 2009, an individual may also be eligible to file a sworn complaint with the Texas Ethics Commission if the individual owns real property in the state of Texas. Under this provision, the complainant will be required to attach to the complaint a copy of a property tax bill, notice of appraised value, or other government document that shows the name of the complainant, shows the address of the real property in Texas, and identifies the complainant as the owner of the real property. OFFICE USE ONLY Docket Number Date Hand-delivered or Date Postmarked I. IDENTITY OF COMPLAINANT 1 COMPLAINANT NAME MS / MRS / MR FIRST MI NICKNAME LAST SUFFIX 2 COMPLAINANT PHYSICAL ADDRESS 3 COMPLAINANT MAILING ADDRESS (check if same as above) ADDRESS APT / SUITE #; CITY; STATE; ZIP CODE (Full home or business address, including street, city, state, and zip code) ADDRESS APT / SUITE #; CITY; STATE; ZIP CODE (Full home or business address, including street, city, state, and zip code) AREA CODE PHONE NUMBER EXT 4 COMPLAINANT TELEPHONE NUMBER 5 COMPLAINANT E-MAIL ADDRESS II. IDENTITY OF RESPONDENT 6 RESPONDENT NAME MS / MRS / MR FIRST MI NICKNAME LAST SUFFIX 7 RESPONDENT POSITION OR TITLE RESPONDENT PHYSICAL ADDRESS ADDRESS APT / SUITE #; CITY; STATE; ZIP CODE 8 (Full home or business address, including street, city, state, and zip code) 9 RESPONDENT MAILING ADDRESS (check if same as above) ADDRESS APT / SUITE #; CITY; STATE; ZIP CODE (Full home or business address, including street, city, state, and zip code) AREA CODE PHONE NUMBER EXT 10 RESPONDENT TELEPHONE NUMBER 11 RESPONDENT E-MAIL ADDRESS (IF KNOWN) GO TO PAGE 2 www.ethics.state.tx.us Revised 09/18/2012 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) III. NATURE OF ALLEGED VIOLATION Page 2 Include the specific law(s) or rule(s) alleged to have been violated. The Texas Ethics Commission has jurisdiction to enforce only the following laws: (1) Title 15 of the Election Code; (2) Chapters 302, 303, 305, 572, 2004 of the Gov't Code; (3) § 334.025 and § 335.055 of the Local Gov't Code; (4) Subchapter C, Chapter 159 of the Local Gov't Code, in connection with a county judicial officer who elects to file a financial statement with the commission; (5) § 2152.064 and § 2155.003 of the Gov't Code; (6) § 306.005 of the Gov't Code. ATTACH ADDITIONAL PAGES AS NEEDED Revised 09/18/2012 American LegalNet, Inc. www.FormsWorkFlow.com www.ethics.state.tx.us Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) IV. STATEMENT OF FACTS Page 3 State the facts constituting the alleged violation(s), including the dates on which or the period of time in which the alleged violation(s) occurred. Identify allegations of fact not personally known to the complainant, but alleged on information and belief. Please use simple, concise, and direct statements. ATTACH ADDITIONAL PAGES AS NEEDED Revised 09/18/2012 American LegalNet, Inc. www.FormsWorkFlow.com www.ethics.state.tx.us Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) V. LISTING OF DOCUMENTS AND OTHER MATERIALS Page 4 List all documents and other materials filed with this complaint. Additionally, list all other documents and other materials that are relevant to this complaint and that are within your knowledge, including their location, if known. ATTACH ADDITIONAL PAGES AS NEEDED www.ethics.state.tx.us Revised 09/18/2012 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) VI. AFFIDAVIT BASED ON PERSONAL KNOWLEDGE (Execute this affidavit if the acts alleged are within your direct personal knowledge.) Page 5 I, , complainant, swear that I am a resident of the state of Texas. I swear that I have knowledge of the facts alleged in this complaint and that the information contained in this complaint is true and correct. Signature of Complainant AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said _____________________________________, this the ____________ day of _____________________________________, 20 ________ , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath VII. AFFIDAVIT BASED ON INFORMATION AND BELIEF (Execute this affidavit if the acts alleged are not within your direct personal knowledge, but are based on reasonable belief.) I, , complainant, swear that I am a resident of the state of Texas. I swear that I have reason to believe and do believe that the violation alleged in this complaint has occurred. The source of my information and belief is Signature of Complainant AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said _____________________________________, this the ____________ day of _____________________________________, 20 ________ , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath www.ethics.state.tx.us Revised 09/18/2012 American LegalNet, Inc. www.FormsWorkFlow.com ********************************************************************************** A COMPLAINT WILL BE DISMISSED IF A COPY OF ONE OF THE FOLLOWING DOCUMENTS IS NOT ATTACHED AS PROOF OF TEXAS RESIDENCY. ********************************************************************************** Please check one of the boxes below to indicate the copy of the d
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