PART ONE: PERSON VIOLATING THE CODE OF ETHICS.
State the name, address, telephone number, and email address of the person who you believe has violated
the Code of Ethics.
Name * County position or title Department or agency Email Address * Phone Number PART TWO: SPECIFIC LAW VIOLATED State the specific section or sections of the Code of Ethics that you believe was violated. * PART THREE: STATEMENT OF FACTS Describe the facts on which this complaint is based, including relevant dates, places, and actions. * PART FOUR: WITNESS INFORMATION. State the names, addresses, telephone numbers, and email addresses of persons with firsthand knowledge of the facts alleged or other information that could help. * PART FIVE: SUPPORTING DOCUMENTS List any records or documents that would assist the Board of Ethics in its investigation. Please mail or deliver to the Ethics Office any documentary evidence that supports the facts. * PART SIX: PERSON MAKING THE COMPLAINT Name Email * Phone Number I agree to receive service of any notice via the email address set forth above I declare under penalty of perjury and false swearing that I have reviewed the information given in this
complaint and, to the best of my knowledge, it is a true, accurate, and complete statement. Signature Received by Completion of this form by a Complainant is not proof of any allegation made. The Board will determine
whether a violation of the DeKalb Ethics Code exists upon investigation and full hearing of the
Complaints should be mailed to:
DeKalb County Board of Ethics
178 Sams Street
Decatur, Georgia 30030