6. Summarize what happened. Use this space for a brief and concise When did the act(s) checked in #3 above occur? (Use the most recent statement of the facts. Additional details and any supporting documents date if several dates are involved) may be submitted as attachments. ______ / ______ / ____________ 7. I declare under penalty of perjury that I have read this complaint (including any attachments) and that it is true and correct. Signature Date For Office Use Only Date Received: Distributed: __________ City Office Clerk’s __________ Legal Department __________ Housing Advisory Commission
6. Summarize what happened. Use this space for a brief and concise statement of the facts. Additional details and any supporting documents may be submitted as attachments. When did the act(s) checked in #3 above occur? (Use the most recent date if several dates are involved) ______ / ______ / ____________ 7. I declare under penalty of perjury that I have read this complaint (including any attachments) and that it is true and correct. Signature Date For Office Use Only Date Received: Distributed: __________ City Clerk’s Office __________ Legal Department __________ Housing Advisory Commission
fair-housing-complaint-form.docx