Stamp Date/Time Received:

       Complaint Number: _______________

Please Type or Print in Ink and Complete this Form.

This complaint concerns a possible violation of: (please check all that apply)

[ ] The Oakland Sunshine Ordinance, California Public Records Act or Brown Act. (Access to public meetings or documents.)

[ ] Oakland Campaign Reform Act

[ ] Oakland City Council's Rules of Procedure/Code of Ethics

[ ] Oakland Limited Public Financing Act

[ ] Oakland Conflict of Interest regulations

[ ] Oakland Lobbyist Registration Act

[ ] Oakland False Endorsement In Campaign Literature Act

[ ] I am/We are not sure which specific law, ordinance or regulations apply. However, I am/We are requesting that the Ethics Commission determine if my/our complaint is within its jurisdiction.

The alleged violation occurred on or about the following date(s)

The alleged violation occurred at the following place:

Please provide specific facts describing your complaint. (Or attach additional pages as necessary.)

The persons you allege to be responsible for the violation(s) are:

Any witnesses who were involved and/or who can provide additional information are: (Please indicate names and phone numbers, if available.)

PLEASE NOTE:

There may be other laws that apply to the violation(s) you are alleging. The time limit to commence a legal proceeding to enforce those laws may not be extended by filing this complaint. You should contact an attorney immediately to protect any rights available to you under the law.

By filing this complaint with the Public Ethics Commission it, and all other materials submitted with it, becomes a public record available for inspection and copying by the public.

NAME:______________________ PHONE NO.(Day):(    ) ___________

ADDRESS:______________________PHONE NO.(Eve.):(    )___________

CITY: _____________ STATE: _____ ZIP: ________

FAX NO.: (     ) ___________

E-MAIL_______________________

Public Ethics Commission
One Frank Ogawa Plaza, 4^th floor
Oakland, CA 94612

Phone: (510) 238-3593
FAX:(510) 238-3315