DATE: _________________________

TO: Grievance Committee - Daytona Beach Area Association of REALTORS®

FROM: ___________________________________________________________________ Complainant(s)

I/We charge that _______________________________________________________ REALTOR® associated with ____________________________________ (real estate firm) has violated Article(s) ______________of the Code of Ethics of the National Association of REALTORS®. The above charge is supported by an attached statement, which is signed and dated.

This complaint is true and correct to the best knowledge and belief of the undersigned.

Under the penalties of perjury, 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?
_____ Yes   _____ No

Have you filed, or do you intend to file, a similar or related complaint with another Association(s) of REALTORS®? _____ Yes   _____ No

If so, name of other Associations(s): _________________________________

Date(s) Filed: ______________________


_____________________________________ /Complainant(s) Signature


_____________________________________ /Complainant's Address



Please return to:

Grievance Committee
Daytona Beach Area Association of REALTORS
1716 Ridgewood Ave
Holly Hill, FL 32117