Ethics Board Complaint Form (PDF)

1 City of Wisconsin Rapids Ethics Board Complaint Form All complaints must be made in writing. Completion of this form is not required, but this form is designed to assist you in providing the required information. Complaints shall be directed to the attention of the Ethics Board of the City of Wisconsin Rapids, c/o City Attorneys Office, 444 West Grand Avenue, Wisconsin Rapids, Wisconsin 54495. The complaint shall be made under oath and may be made on information and belief. Complainant Information: Your name: Address: Home phone: Email address: Subject of Complaint: Subject’s Position/Occupation with the City: The purpose of the Ethics Board is to see that the Code of Ethics as outlined in Chapter 26 of the Wisconsin Rapids Municipal Code is uniformly applied to all City of Wisconsin Rapids employees and officials. The areas of responsibility include, but are not limited to, (a) Fair and Equal Treatment, (b) Conflict of Interest, (c) Incompatible Employment, (d) Disclosure of Privileged Information, (e) Gifts and Favors, (f) Contracts with the City, (g) Campaign Contributions, (h) Disclosure of Interest in Legislation. Nature of Complaint: The Nature of the Complaint is a short general statement of the alleged breach of ethics. For example, a statement related to a violation of the above-listed areas of responsibility is appropriate. Section of Municipal Code Violated: 2 Facts: The facts constituting the alleged breach of ethics must be set forth in detail with clearness and certainty. Please reference specific sections within the Wisconsin Rapids Municipal Code which you believe to have been violated. Attach additional sheets as required. The undersigned, under oath, states that he or she has read the foregoing complaint and that the information contained in it is true and correct based on his or her personal knowledge, except for those matters alleged on information and belief and as to those matters, the undersigned believes them to be true and correct. Subscribed and sworn before me this day of , 202 . NOTARY PUBLIC My Commission Expires (Is Permanent) Send Complaint Form to: Ethics Board c/o City Attorneys Office City of Wisconsin Rapids 444 West Grand Avenue Wisconsin Rapids WI 54495