LOS ANGELES CITY ETHICS COMMISSION …

                           LOS ANGELES CITY ETHICS COMMISSION
                                  COMPLAINT FORM



        The Los Angeles City Ethics Commission has the authority to investigate violations of
State and City campaign finance, governmental ethics and lobbying laws. If you have a question
regarding whether your complaint is within our jurisdiction, please call us at (213) 978-1960.

         We take every complaint we receive seriously. Please bear in mind, however, that often
we do not have the authority to take action regarding a complaint. If this should happen, we will
refer your complaint to the appropriate agency. In addition, please note that we cannot provide
injunctive relief ­ we cannot order someone to stop his or her activity immediately.

         You may make your complaint anonymously. If you do give us your name, we will not
release it unless we receive your permission or unless we refer the complaint to another law
enforcement agency for criminal prosecution. You are protected against retaliation for blowing
the whistle on your co-workers or superiors. The Ethics Commission does not confirm or deny
the existence of any investigation until the matter is closed.

        Once we receive your complaint, we will not contact you unless we need additional
information. You can call us to check on the status of your complaint, but please keep in mind
that generally it takes 30 days for a complaint to be processed. If a full-fledged investigation is
conducted as a result of your complaint, the investigation could take several months.

         The more information you can give us, the more helpful you will be. Please complete
this form as fully as possible .

Person making Complaint:

Your Name: (optional)         _____________________________________________________


Your address: (optional)      _____________________________________________________


                                _____________________________________________________


Your Phone Number: (optional)             ___________________________________________

Person or Entity that allegedly violated State or City laws :

Name and Title of Subject of Complaint: _________________________________________


Place of Employment of Subject of Complaint: _____________________________________

___________________________________________________________________________
Nature of Complaint: (please include as much detail as possible ­ dates, names, etc.);




(Attach additional sheets if necessary. In addition, please attach copies of any available
documentation regarding the alleged violation.)

Describe the laws that were violated (as specifically as possible): ______________________



Names and addresses of persons who may have information that could help us:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

DECLARATION OF COMPLAINANT (optional):
I certify under penalty of perjury under the laws of the State of California that the foregoing is
true and correct.

Date:_______________________________________________________

At: _______________________________________________________

Signature:___________________________________________________

Please return by mail or fax to (213) 978-1989:
        Los Angeles City Ethics Commission
        Attn: Enforcement Division
        200 N Spring Street
        City Hall - 24th Floor
        Los Angeles, CA 90012