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Date *

Name *

Email *

Address *

Daytime Phone *

Evening Phone *

Describe Issue *

Violator's Name *

Violator's Address *

Violation Date *

Witness Name *

Witness Address *

Witness Phone *

Checkboxes *

I Agree

I have made the above statement based on personal knowledge and not upon what has been told to me. I will cooperate with the association and its attorney to provide any additional statements or affidavits, and in the event a hearing or trial is necessary, I will appear to testify as a witness.