Outagan1ie Melinda J.

Tempelis, District Attorney

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Government Center
320 S. Walnut Street, Appleton, WI 54911
OFFICE OF THE DISTRICT ATTORNEY Telephone: (920) 832-5024 Fax: (920) 832-5031
Outagamie.general@da.wi.gov
Verified Complaint
Please provide the following information about yourself:

Your name Telephone number

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Email Address

Street address City State Zip code

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Instructions:

• Clearly identify each person, committee, or group that is alleged to have committed a violation (called the respondent);
• Clearly recite the facts that show specific violations under the District Attorney's jurisdiction (citations to the law
and administrative code are not necessary, but helpful);
0 Be as specific as possible as it relates to dates, times, and individuals involved.
• Differentiate between statements based on the complainant's (the person who files the complaint) personal knowlec
and those based on information and belief. Statements not based on personal knowledge should identify the source
the information;
• Include any and all documentation you have or can obtain supporting the allegations; and
• Use as many separate pages as needed and attach copies of any supporting documentation.

Please send or bring this completed form to:

Mail or in person:
Outagamie County District Attorney's Office
320 South Walnut Street
Appleton, WI 54911

State of Wisconsin before the Outagamie County District Attorney

_____ _______________ __ ___ , Complainant(s) against

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whose address is_...._!_C?�o_o__u)

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This complaint is under /({8 :f-� (/) (Insert the applicable sections of law
under chapter 19.59 of Wisconsin Statutes)