Approved 10/15/03 R&R/W&S
GVM Complaint Form
Complaint Category:
o R&R
o W&S
o ARC
Complaint Against:
Name of Member ____________________________________________
Address ___________________________________________________
Filing ________ Lot__________
Details/Nature of Complaint:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Board Action Taken:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Complaint Filed By:
(CONFIDENTIAL) (CONFIDENTIAL) (CONFIDENTIAL)
Name of Member __________________________ Filing______ Lot______
Signature _______________________________ Date _________________
Received by ____________________________________________________
Approved 10/15/03 R&R/W&S
Policy and Procedure for Member Complaints
Approved 4/20/02
DEFINITION: PA - the Presiding Agent/Agency having jurisdiction for the complaint.