Sworn Affidavit Complaining Of Violation printable pdf download

SWORN AFFIDAVIT COMPLAINING OF VIOLATION

OF LAW OR RULES AND REGULATIONS

STATE OF LOUISIANA

PARISH OF___________________________________

BEFORE ME, the undersigned authority, personally came and appeared __________________________

_________________________________________, a resident of the lawful age of majority of the Parish of

_______________________________State of ___________________________ whose mailing address is

___________________________________________________________________________________________,

Phone__________________ who, after being duly sworn, deposed and says:

This Complaint is made against ____________________________________________, whose address and

telephone number is __________________________________________________________________________.

The Complaint against the aforesaid person/s is (state facts upon which claim is based; attach additional

sheet, if necessary):___________________________________________________________________________

___________________________________________________________________________________________

_________________________________________

Signature

SWORN TO AND SUBSCRIBED BEFORE ME THIS _________DAY OF _________________,

_________________________________________

Notary

Return this form to:

LOUISIANA STATE BOARD OF ARCHITECTURAL EXAMINERS

9625 Fenway Avenue, Suite B

Baton Rouge, LA 70809

Telephone: 225-925-4802 Fax: 225-925-4804

Affidavit Complaint

02/15/2011

Sworn Affidavit Complaining Of Violation