AFFIDAVIT
OF
COMPLAINT
STATE ELECTIONS
ENFORCEMENT COMMISSION
Revised July 2012
Please complete this form to the fullest extent possible. The following sections are required
and
must
be completed in full:
Page 1
of6
I
Identity
ofComplainant s)-page
I
III. Violation(s)
Alleged-page
3
I
VI. Certification-page
6
I.
IDENTITY
OF
COMPLAINANT(S)
COMPLAINANT S NAME
First Name MI
Last
Name
G
fl.tt-E -
COMPLAINANT S STREET ADDRESS
Address City
COMPLAINANT S TELEPHONE NUMBER
I
ell
COMPLAINANT S EMAIL ADDRESS COMPLAINANT S NAME
First Name
(
Y/l/lll /;
Last Name
D
uETV VJNGS
COMPLAINANT S STREET ADDRESS
Address
861/~~e Z&Jo
~
COMPLAINANT S TELEPHONE NUMBER
Home
I
ork
COMPLAINANT S EMAIL ADDRESS COMPLAINANT S NAME
First Name MI Last Name
COMPLAINANT S STREET ADDRESS
Address City
COMPLAINANT S TELEPHONE NUMBER
Home
I
ork
I
ell
COMPLAINANT S EMAIL ADDRESS
__
;
I
( )
Suffix Zip Code
06\0S
Suffix State Zip Code
CT
00112
I
Suffix State Zip Code
I
 
AFFIDAVIT
OF
COMPL INT
STATE ELECTIONS ENFORCEMENT COMMISSION
Revised
July
2012
Page 2
of6
II. IDENTITY
OF
RESPONDENT S)
RESPONDENT S NAME
(Jfknawn; atherwisewrite unknown )
First Name
E ·
Ml
Last
Name
Suffix
r
(
[
PMC\{\
i..
·
RESPONDENT S
STREET ADDRESS
dJknown)
Address
·;·7
l
~\ ~
JJ
.
~
'
\\\1
iv
City
.
.
··
\
6
j
State Zip Code
t
~
6
()
r \
\
Ci
(J(,J)l
RESPONDENT S TELEPHONE
NUMBER
If
known)
Home
I
ork
I
ell
RESPONDENT S
EMAIL
ADDRESS
If
known)
STATUTE S)
VIOLATED
If
known)
§
RESPONDENT S
NAME
If
known, otherwise write unknown )
First Name
MI
Last
Name
Suffix
RESPONDENT S STREET ADDRESS
(Jfknown)
Address City State Zip Code
RESPONDENT S
TELEPHONE NUMBER
If
known)
Home
I
ork
I
ell
RESPONDENT S EMAIL ADDRESS
If
known)
STATUTE S)
VIOLATED
(Jfknown)
§
RESPONDENT S
NAME
If
known, otherwise write unknown )
First Name
MI
Last Name Suffix
RESPONDENT S STREET ADDRESS
{If
known)
Address City State Zip Code
RESPONDENT S TELEPHONE
NUMBER
(Ifknown)
Home
I
ork
JCell
RESPONDENT S EMAIL ADDRESS
If
known)
STATUTE(S) VIOLATED
If
known)
§
Copy
and
attach page(s)
for
additional respondents
if
necessary. Please check See attached Additional Respondent List
and
list the number
of
pages.
See attached Additional Respondent List pages
Number
of
Pages
 
 
AFFIDAVIT OF COMPLAINT
STATE ELECTIONS ENFORCEMENT COMMISSION
Revised
July
2012
III. VIOLATION(S) ALLEGED
DATE S)
OF
ALLEGED
VIOLATION(S)
If
known)
CONCISE STATEMENT
OF
FACTS
Page 3
of6
Please be
s
specific
s
possible with regard to time, place, and the individual(s) taking actions or failing to act, and
in
de-scribing their actions as well as other witnesses or persons involved.
If
applicable, please clearly refer to the names
of
identi-fled respondents, witnesses, and attached evidence (e.g., See Evidentiary Attachment B.).
If
you have identified more than one respondent, please identify which respondent is alleged to have committed which action and which specific alleged violation
of
the statutes.
If
you are unable to provide the specific identity
of
any witnesses in the following
Witnesses
section, please provide
s
much identifying information
s
possible in the below
Concise Statement
o
Facts.
The respondent(s) allegedly violated the law as follows:
\
\ fl
/:
l~
\A{
f \
y
\_
v
\,1
'' \
j\
u
Use
attached
page
s)
for
additional statement
of
acts
if
necessary. Please check See attached Additional Statement
of
Facts
and
list the number
of
pages.
~ hed
Additional Statement
of
Facts pages
Number
r
Pages
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