ETH - Complaint - SFN 61868

COMPLAINT
NORTH DAKOTA ETHICS COMMISSION
SFN 61868 (2-2024)
Case Number
Before filling out this form, please read the following:
• Complaints filed with the Commission are confidential until and unless the Commission determines a violation occurred.
• The Commission can only consider complaints against a lobbyist, public official, candidate for statewide public office including legislative assembly, an elected or appointed official of the state’s executive or legislative branch, members of the Ethics Commission, members of the governor’s cabinet, or employees of the legislative branch.
• We have no authority to investigate personnel matters. These include grievances, appointments, promotions, reprimands, suspensions, dismissals, harassment, and discrimination.
• We have no authority over city or county officials, employees of the state’s executive branch or members of the state’s judicial branch.

If you have questions about this form or would like to request the form in an alternate format, contact the Ethics Commission at (701) 328-5325. We will take reasonable steps to accommodate your needs.
CONTACT INFORMATION

You are required to provide your name, address, and contact information in order to process this complaint and to keep you updated on the progress of our investigation, or to consult with you regarding the details of your complaint if it is approved for investigation. Prior to submitting this complaint, you will have the option to request that your identity remain confidential.
Name*
Phone Number 1
Phone Number 2
Email*
Address*

Street Address Line 2

CityState

Zip Code
File a separate complaint for each individual you complain against.

COMPLAINT DETAILS
1a. Name of Person the Complaint is Against*
1b. Job Title or Position
2. Date(s) of the Alleged Violation(s)*
3. How has this person violated laws or rules related to ethics? Please provide as much information about the alleged violation as possible. Please be specific and provide details. Speculation of a violation is insufficient.*
Attach supporting documentation to support your claim specified in Item 3

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4. If known, indicate which law, rule or other legal requirement you believe has been violated.
5. Provide information for anyone else who may have information regarding this complaint:
6. Has the conduct you describe above been the subject of a prior complaint?

YesNoUnknown
Explain Prior Complaint
7. Describe any other information the Ethics Commission should know about this complaint:

8. Under Section 54-66-05(3) of the North Dakota Century Code, the Ethics Commission may not release your name or address to the accused individual without your authorization. We ask that you indicate whether you authorize the Ethics Commission to release your name and address to the accused individual.

You should know that if you choose to keep your name and address confidential from the accused individual, any statement(s) in your complaint may not be used as evidence of a violation.

You should also know that if you choose to keep your name confidential, but you otherwise disclose or share information that identifies you as a complainant, the Commission may share your name with the individual.
Confidentiality Option:*

I wish my name and address to remain confidential at this time.I DO NOT wish my name and address to remain confidential at this time.
Certification*

I certify that the information provided in this complaint is true, correct, complete, and of my own personal knowledge. I will fully cooperate in the process regarding this complaint.
Signature (typed name is acceptable)*
Date*

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Date
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