Code of Conduct - Complaint Form 1

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Code of Conduct - Formal Complaint Form #1

AFFIDAVIT

PLEASE NOTE: This form is fillable but you will have to come into the office to sign the Affidavit in front of a Commissioner of Oaths.

of the Municipality of

in the Province of

MAKE AN OATH AND SAY (or AFFIRM):

1. I reside at:

My telephone number is:

My email address is:

2. I have reasonable and probable grounds to believe that:

a member of the Council of the Corporation of the Township of West Lincoln or a local board of the Township, has contravened section(s):

The particulars of which are attached hereto (please provide any additional documentation)

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3. Facts constituting the alleged contravention

This affidavit is made for the purpose of requesting that this matter be reviewed and/or investigated by the Township of West Lincoln's Integrity Commissioner and for no improper purpose.

SWORN (or AFFIRMED) before me at

the _______________________ of _________________________________

on the _____________________ day of _____________________________

__________________________________________

A Commissioner for taking affidavits etc.

Signature of Complainant (To be signed in front of a Commissioner)

Please note that signing a false affidavit may expose you to prosecution under ss. 131 and 132 or 134 of the Criminal Code, R.S.C. 1985, c. C-46 and also to civil liability for defamation.

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Code of Conduct - Formal Complaint Form #1

AFFIDAVIT

MAKE AN OATH AND SAY (or AFFIRM):