Withdrawal Form
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Withdrawal Form. This is a Massachusetts form and can be use in Commission Against Discrimination Statewide.
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Tags: Withdrawal Form, Massachusetts Statewide, Commission Against Discrimination
COMMONWEALTH OF MASSACHUSETTS
COMMISSION AGAINST DISCRIMINATION
From:
To:
COMMISSION AGAINST DISCRIMINATION
One Ashburton Place, Room 601
Boston, MA 02108
617-994-6000
FAX: 617-994-6024
RE:
_______________________________________________________
MCAD Docket Number:
(EEOC Number:
)
Dear Commissioner:
I hereby request permission to withdraw my complaint filed with this Commission
for the following reason:
(
)
I wish to file a private right of action in civil court.
( )
I have reached a satisfactory settlement with the Respondent.
( )
I no longer intend to pursue this matter at the Commission.
If applicable, I also wish to withdraw this complaint from the Equal Employment
Opportunity Commission.
I have been advised that it is unlawful for any person or persons to threaten,
intimidate, or harass me because I filed a complaint. I have not been coerced into requesting
this withdrawal.
_______________
Date
_________________________
SIGNATURE
Complainant or Complainant Attorney
_________________________
PRINT NAME
WITHDRAWAL FORM – MCAD
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