Last updated: 10/5/2023
Withdrawal Form
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Description
COMMONWEALTH OF MASSACHUSETTS COMMISSION AGAINST DISCRIMINATION From: To: COMMISSION AGAINST DISCRIMINATION One Ashburton Place, Room 601 Boston, MA 02108 617-994-6000 FAX: 617-994-6024 RE: _______________________________________________________ MCAD Docket Number: (EEOC Number: ) Dear Commissioner: I hereby request permission to withdraw my complaint filed with this Commission for the following reason: ( ) I wish to file a private right of action in civil court. I have reached a satisfactory settlement with the Respondent. I no longer intend to pursue this matter at the Commission. () () If applicable, I also wish to withdraw this complaint from the Equal Employment Opportunity Commission. I have been advised that it is unlawful for any person or persons to threaten, intimidate, or harass me because I filed a complaint. I have not been coerced into requesting this withdrawal. _______________ Date _________________________ SIGNATURE Complainant or Complainant Attorney _________________________ PRINT NAME WITHDRAWAL FORM MCAD American LegalNet, Inc. www.FormsWorkFlow.com
