Ethics Complaint Form E-1

To the Grievance Committee of the Medina County Board of REALTORS®

First and Last Name(s) of Complainant(s)
First and Last Name(s) of Respondent(s)

Complainant(s) charge(s):

Article, Section

And alleges that the above charge(s) (is/are) supported by the following or attached statement, which is signed and dated by the complainant(s) below.

Narrative or chronological summary of the events giving rise to your complaint
If your narrative or summary of events is in a separate file, you may attach it here:
Maximum upload size: 1.5MB
Attach Statement (.pdf, .doc, .docx)

This complaint is true and correct to the best knowledge and belief of the undersigned and is filed within one hundred eighty (180) days after the facts constituting the matter complained of could have been known in the exercise of reasonable diligence.

I (we) declare that to the best of my (our) knowledge and belief, my (our) allegations in this complaint are true.

Are the circumstances giving rise to this ethics complaint involved in civil or criminal litigation or in any proceeding before the state real estate licensing authority or any other state or federal regulatory or administrative agency? *
Have you filed, or do you intend to file, a similar or related complaint with another Association(s) of REALTORS®? *
I understand that should the Grievance Committee dismiss this ethics complaint in part or in total, that I have twenty (20) days from my receipt of the dismissal notice to appeal the dismissal to the Board of Directors.


Name of Complainant
Sign or type you signature
Street address, City, State, Zip
Where you will be sent a copy of your submitted form.