Complaint Form Signature: _____________________________________

Date:

Name:

Div/Lot: __________________

___________________________________________________

Address: ___________________________________________________ Phone:

___________________________________________________

E-mail:

___________________________________________________

____________________

For office use — leave blank

Received: ________________ Resolved: ________________

Nature of Offense: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

Describe solutions offered or actions taken to try to resolve this issue amicably and without Board intervention. (Please attach copies of relevant documentation): ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

CR/CW HOA P.O. Box 58397 Renton, Washington 98058-1397 Tel: 425.227.4227