VERIFIED COMPLAINT FORM COMMISSION ACTION ON COMPLAINT: Your complaint will be investigated by a member of the Commission assigned to the matter (Commission Liaison), with the assistance of Commission staff and the assigned prosecuting attorney from the Office of the Attorney General if the allegations of the complaint indicate that a violation of the Real Estate Licensing Law or Commission rules may have occurred. The Commission’s investigator will likely contact you during the investigation. Please advise the investigator if your contact information changes or there are additional developments related to your complaint. If you resolve your differences with those complained about and/or wish to withdraw your complaint, the Commission will consider your request to dismiss the case; however, it may not grant it. When the investigation is complete, the Commission Liaison will consider the investigative materials, including mitigating and aggravating factors, and decide what action or recommendations may be appropriate, including dismissal (if there is no apparent violation or circumstances do not warrant discipline), informal discipline, or setting the matter for hearing, which may be tabled pending resolution of settlement. If a matter is set for hearing, you may be called as a witness. The case against an accused licensee at any hearing will be presented by the assigned Assistant Attorney General. You will be advised of the case outcome. Thank you for your interest and cooperation. DISCLAIMER: The Wyoming Real Estate Commission cannot act as a court of law, order that monies be refunded, interpret or cancel contracts, and/or award damages. Since we cannot give legal advice, or act as your attorney, you should consult your own legal counsel.
INSTRUCTIONS: Please type or print clearly, completing all applicable sections of this form. The accuracy and legibility of the form will assist in the processing of your complaint. Attach all related documents and feel free to attach additional sheets. If you need assistance, please contact the Commission office. I. COMPLAINANT(S) NAME(S):
ADDRESS:
CITY, STATE, ZIP:
HOME/CELL PHONE: BUSINESS PHONE: OCCUPATION: EMAIL:
Revised: 06 June 2017
II. LICENSEE(S) INVOLVED NAME OF LICENSEE:
TYPE OF LICENSE HELD: SALESMAN NAME OF FIRM:
ASSOCIATE BROKER
RESPONSIBLE BROKER
ASSOCIATE BROKER
RESPONSIBLE BROKER
ADDRESS OF FIRM:
FIRM’S RESPONSIBLE BROKER: LICENSEE(S) INVOLVED NAME OF LICENSEE:
TYPE OF LICENSE HELD: SALESMAN NAME OF FIRM:
ADDRESS OF FIRM:
FIRM’S RESPONSIBLE BROKER: IV. CONTACT WITH LICENSEE OR FIRM (please indicate contact with an X): _____ I HAVE contacted parties involved in this complaint and attempted to resolve this matter.
_____ I HAVE NOT contacted parties involved in this complaint and attempted to resolve this matter. PLEASE LIST INDIVIDUALS CONTACTED WITH DATES (if applicable):
PLEASE SUMMARIZE THE RESULTS OF CONTACT THUS FAR (if applicable):
V. CONTACT WITH ATTORNEY (please indicate contact with an X): _____ I HAVE contacted an attorney to assist in resolving this matter.
_____ I HAVE NOT contacted an attorney to assist in resolving this matter. ATTORNEY NAME (if applicable): ATTORNEY ADDRESS: ATTORNEY PHONE:
VI. ACTIONS IN A COURT OF LAW Please indicate any matters of law relating to this complaint: ____ This complaint has been filed in a court of law ____ This complaint will be filed in a court of law
____ This complaint may be filed in a court of law ____ Other (please explain):
Please list the following information if action has been taken or is filed in a court of law: COURT NAME:
COURT ADDRESS: CASE NUMBER:
TYPE OF ACTION:
CASE STATUS:
VII. APPEARING UNDER OATH Please indicate which of the following you prefer (NOTE: A complainant’s unwillingness to testify may be the basis for the Commission to dismiss a complaint after its investigation and consideration): ____ I AM willing to appear under oath as a witness, subject to cross-examination concerning the allegation(s) made in this complaint.
____ I AM NOT willing to appear under oath as a witness, subject to cross-examination concerning the allegation(s) made in this complaint. VIOLATIONS and EVIDENCE
Please complete the following sections (attach additional sheets if necessary): a.
Identify the specific statutes (laws) or regulations you allege were violated in this complaint:
b. Please state all facts relating to the case and provide dates and places. The more specific you can be, the better.
c.
Attach clear, readable copies of all pertinent documents or papers that relate to this complaint.
VIII. SIGNATURES I, (we), the Complainant(s), declare under oath that the above is true to the best of my (our) knowledge and belief. Dated this _______ day of _________, 20 COMPLAINANT COMPLAINANT NOTARIZED
State of ____________________________, County of ________________________ ) )ss )
Subscribed and sworn to before me, a notary public, this __________ day of _____________, 20
by _________________________ and ____________________________. Witness my hand and official seal.
My commission expires:
Notary Public
