2016 0219 Attorney General Ethics Complaint Form
OSAGE NATION OFFICE OF THE ATTORNEY GENERAL Holli A. Wells Attorney General
1071 Grandview Lane Pawhuska, OK 74056
Clint Patterson 1st Asst. Attorney General
ETHICS COMPLAINT FORM 15 ONC § 6-101 et seq. Complainant’s Contact Information Name
Phone #
Street Address
City, State, Zip By completing this form, you are filling out a formal complaint against an individual Osage Nation Elected or Appointed Official or Osage Nation employee pursuant to 15 ONC § 6-101 et seq. In order to investigate your complaint, you must provide sufficient information and provide a summary of all evidence and witnesses available to you. Please note that any investigation must be based on facts or circumstances that you personally observed or heard. If you do not have personal knowledge of a fact or circumstance, you must provide sufficient information to permit us to contact the individual who does have such knowledge. The Attorney General will only file an ethical complaint if the complainant has standing and if there is sufficient basis for prosecution.
Complaint Information Date of Incident
Place of Incident
If your complaint is against an Osage Nation Elected or Appointed Official, list the name of the individual and the branch or board or commission with whom the individual is associated. If your complaint is against an Osage Nation Employee, list the individual’s name, position, and department. Describe the incident in detail and any injuries, if any, that you received as a result of the incident.
(Please continue to next page)
List any evidence you can provide to support your complaint Name, Address, and Phone Number of Witnesses
Brief Summary of evidence to be provided by witness
1. 2. 3.
List any documents available to you or to any witness
Copies are attached
1.
Yes
No
2.
Yes
No
3.
Yes
No
Please attach additional pages if needed.
By signing this complaint form, you swear and affirm the above information is true and accurate to the best of your knowledge.
Signature is required:________________________________________________Date:___________________ The Attorney General does not guarantee an investigation or inquiry. Furthermore, you must understand that the Attorney General is not your private attorney. Any ethical complaint brought by the Attorney General is on behalf of the Osage Nation, not you as an individual.
FOR OFFICE USE ONLY Disposition of Complaint: Investigation
Inquiry
No Action Taken—Reason:__________________________________ __________________________________
1071 Grandview Lane Pawhuska, OK 74056
Clint Patterson 1st Asst. Attorney General
ETHICS COMPLAINT FORM 15 ONC § 6-101 et seq. Complainant’s Contact Information Name
Phone #
Street Address
City, State, Zip By completing this form, you are filling out a formal complaint against an individual Osage Nation Elected or Appointed Official or Osage Nation employee pursuant to 15 ONC § 6-101 et seq. In order to investigate your complaint, you must provide sufficient information and provide a summary of all evidence and witnesses available to you. Please note that any investigation must be based on facts or circumstances that you personally observed or heard. If you do not have personal knowledge of a fact or circumstance, you must provide sufficient information to permit us to contact the individual who does have such knowledge. The Attorney General will only file an ethical complaint if the complainant has standing and if there is sufficient basis for prosecution.
Complaint Information Date of Incident
Place of Incident
If your complaint is against an Osage Nation Elected or Appointed Official, list the name of the individual and the branch or board or commission with whom the individual is associated. If your complaint is against an Osage Nation Employee, list the individual’s name, position, and department. Describe the incident in detail and any injuries, if any, that you received as a result of the incident.
(Please continue to next page)
List any evidence you can provide to support your complaint Name, Address, and Phone Number of Witnesses
Brief Summary of evidence to be provided by witness
1. 2. 3.
List any documents available to you or to any witness
Copies are attached
1.
Yes
No
2.
Yes
No
3.
Yes
No
Please attach additional pages if needed.
By signing this complaint form, you swear and affirm the above information is true and accurate to the best of your knowledge.
Signature is required:________________________________________________Date:___________________ The Attorney General does not guarantee an investigation or inquiry. Furthermore, you must understand that the Attorney General is not your private attorney. Any ethical complaint brought by the Attorney General is on behalf of the Osage Nation, not you as an individual.
FOR OFFICE USE ONLY Disposition of Complaint: Investigation
Inquiry
No Action Taken—Reason:__________________________________ __________________________________
