Code of Ethics Violation Complaint Form (PDF)

Complaint of Violation of Code of Ethics 
 
Please provide the information requested below and attach additional sheets if necessary: 
 
1. Identify the person who is alleged to have violated the Ethics Code. 
 
 
 
 
 
2. Specific Code of Ethics Violation:  Section 2.50.030 ___  [insert applicable subsection’s letter] 
Go to https://www.waterfordct.org/ (click on Ordinances/Policies) or contact the Town Clerk for a hard copy of the Ethics Code. 
 
3. Provide a detailed explanation of the nature of the violation. Include dates, places and corroborating witnesses or 
documents, if any. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signed by: ______________________________________ 
Date: ____________ 
Print Name:   ____________________________________ 
Email:  ________________________________________ 
Address:  _______________________________________ 
Telephone:  _________________________ 
 
So acknowledged this   _____   day of   ____________________   __________   before me: 
 
date 
month 
year 
Witnessed by:  ______________________________________ 
Position:  _____________________________________ 
Print Name:  ______________________________________ 
 
Witness must be (1) a judge of a court of record, (2) a clerk or deputy clerk of a court having a seal, (3) the town clerk,  
(4) a notary public, (5) a justice of the peace, or (6) an attorney admitted to the bar of this state. 
 
Mail or hand-deliver completed form to Ethics Commission c/o Town Clerk, 15 Rope Ferry Rd, Waterford CT 06385 
 Name:  _____________________________________________________________________________ 
 Title or Position:  _____________________________________________________________________ 
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