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\sbasedon0 \snext29 Subtitle;}{\s30\qc\widctlpar\adjustright \fs28\cgrid \sbasedon0 \snext30 Title;}}{\info{\title J:\\NCHRC\\HOUSING\\1FORMS\\COMPPACK.SAM}{\author Human Relations}{\doccomm complaint pack}{\operator Bob Minges}
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\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}\pard\plain \widctlpar\tx720\tx1440\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\adjustright \fs20\cgrid {\f1\fs24\cf1 
\par 
\par }\pard \qc\widctlpar\tx720\tx1440\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\adjustright {\b\f1\fs24\ul\cf1 (today\rquote s date)
\par 
\par HOUSING DISCRIMINATION COMPLAINT
\par }\pard \widctlpar\tx720\tx1440\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\adjustright {\b\f1\fs24\ul\cf1 
\par }{\b\f1\fs24\cf1 CASE NUMBER:\tab \tab 
\par 
\par 1.\tab Complainant(s)
\par }{\f1\fs24\cf1 
\par 
\par 
\par }{\b\f1\fs24\cf1 2.\tab Other Aggrieved Persons
\par }{\f1\fs24\cf1 
\par 
\par 
\par }{\b\f1\fs24\cf1 3.\tab The following is alleged to have occurred or is about to occur:
\par }{\f1\fs24\cf1 
\par 
\par 
\par }{\b\f1\fs24\cf1 4.\tab The alleged violation occurred because of:
\par }{\f1\fs24\cf1 
\par 
\par 
\par }\pard \fi-720\li720\widctlpar\tx720\tx1440\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\adjustright {\b\f1\fs24\cf1 5.\tab Address and loc
ation of the property in question (or if no property is involved, the city and state where the discrimination occurred):
\par }\pard \widctlpar\tx720\tx1440\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\adjustright {\f1\fs24\cf1 
\par 
\par }{\b\f1\fs24\cf1 6.\tab Respondent(s)
\par }{\f1\fs24\cf1 
\par 
\par 
\par }\pard \fi-720\li720\widctlpar\tx720\tx1440\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\adjustright {\b\f1\fs24\cf1 7.\tab The following is a brief and concise statement of the facts regarding the alleged violation:
\par }\pard \widctlpar\tx720\tx1440\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\adjustright {\f1\fs24\cf1 
\par 
\par 
\par }{\b\f1\fs24\cf1 8.\tab The most recent date on which the alleged discrimination occurred:
\par }{\f1\fs24\cf1 
\par 
\par 
\par }{\b\f1\fs24\cf1 9.\tab Types of Federal Funds identified:
\par }{\f1\fs24\cf1 
\par 
\par 
\par }\pard \fi-720\li720\widctlpar\tx720\tx1440\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\adjustright {\b\f1\fs24\cf1 10.\tab The acts alleged in this complaint, if proven, may constitute a violation of the following:
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\par 
\par Please sign and date this form:
\par 
\par I declare that I have read this complaint (including all attachments) and certify that it is true and correct, to the best of my knowledge.
\par }{\f1\fs24\cf1 
\par 
\par __________________________________\tab \tab \tab ___________________
\par (Type Complainant\rquote s name)\tab \tab \tab \tab \tab \tab Date
\par 
\par 
\par }\pard \fi-90\widctlpar\adjustright {\b\f1\fs24\cf1 N O T E:\tab HUD WILL FURNISH A COPY OF THIS COMPLAINT TO THE PERSON OR ORGANIZATION AGAINST WHOM IT IS FILED.}{\b 
\par }}