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Formal Code of Conduct Complaint Form

Last Name

First Name

Street Address

Town/City

Postal Code

Phone Number

Personal Knowledge of Facts (i.e. I work for...; I attended a meeting at which...., etc.)

Name of Member of Council in Question

Section(s) of Code of Conduct Contravened

Statement of Fact

The submitted Code of Conduct Complaint Form is made for the purpose of requesting that this matter be reviewed by the Town of Tillsonburg appointed Integrity Commissioner and for no other purpose.

Declaration

I declare that the information as provided by me on this Formal Code of Conduct Complaint Form is true and correct to the best of my knowledge.

The personal information collected on this form is collected under the authority of the Municipal Act, 2001, as amended and will be used solely for the purposes related to the complaint, the investigation and subsequent report therein.

Questions about this collection should be addressed to the Town Clerk, 519-688-3009 Ext. 3224.