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Code of Conduct Complaint Form

The Corporation of the Municipality of Centre Hastings

Formal Municipal Integrity Commissioner Complaint Inquiry Form

I, (Full Name) of the Municipality of (Name Municipality) in the province of Ontario do solemnly swear (affirmed or declare) that the following contents of this affidavit as subscribed are true and correct.

Full Name

Name Municipality

Permanent Place of Residence

Mailing Address (if different than Permanent Place of Residence)

I have personal knowledge of the facts as set out in this affidavit and as outlined below to be true.

I have reasonable and probable grounds to belive that (Specify Name of Member) has contravened (Section(s)) of the Municipal Code of Conduct for the Municipality of Centre Hastings.

Specify Name of Member

Section(s)

The particulars are as follows:

This affidavit is made for the purpose of requesting this matter be reviewed by the Council appointed Municipal Integrity Commissioner pursuant to Section 223.3 of the Municipal Act, 2001, as amended, and for no other purpose.

Signature of Requester

Clear

Date

Note: This is a sworn (affirmed) affidavit of the deponent only. No investigation has been conducted to confirm or verify the above and attatched sworn information. THE CRIMINAL CODE OF CANADA provides that: everyone commits perjury who, with intent to mislead, makes before a person who is authorized by law to permit it to be made before him/her a false statement is false, is guilty of an indictable offence and is liable to a term of imprisonment not exceeding fourtneen years (section 131, 132) or by summary conviction (section 134). Signing a false affidavit may expose you to prosecution under Section 131 and 132 or 134 of the Criminal Code, R.S.O 1985, c. C-46 and also civil liability for defamation.