Commonwealth of Pennsylvania State Ethics Commission SEC226 REVISED INSTRUCTIONS IMPORTANT No public official or public employee shall discharge any official or employee or change official rank, grade or compensation, or deny a promotion or threaten to do so for filing a complaint with or providing information to the Commission or testifying in any Commission proceeding. Confidentiality The Commission will keep information, records, and proceedings relating to preliminary inquiries and investigations confidential (this includes the identity of the Complainant, unless there has been a rongful se of ct as defined below). The Commission may disclose information or records regarding a preliminary inquiry or investigation in relation to: Final orders of the Commission which become public.Hearings conducted in public, as provided by law.Appeal of Commission orders.Seeking the dvice of egal ounsel.Consulting with a law enforcement official or agency for the purpose of initiating, participating in or responding to an investigation orprosecution by the law enforcement official or agency.Testifying under oath before a governmental body or a similar body of the United States of America.The provision of discovery materials to the subject of an investigation, as required by law.When necessary or incidental to the conduct of on-going investigations or inquiries. Penalties Any person who engages retaliatory activity proscribed by Section 8(j)a misdemeanor and in addition to any other penalty provided by law, shall be fined not more than $1,000 or imprisoned for not more than one year or be both fined and imprisoned. Any person who willfully affirms or swears falsely in regard to any material matter before a Commission proceeding pursuant to Section a felony and shall be fined no more than $5,000 or imprisoned for not more than five years, or be both fined and imprisoned. Wrongful Use of Act Any filing a complaint with the State Ethics ommission should be aware of the following provisions of the Ethics American LegalNet, Inc. www.FormsWorkFlow.com Commonwealth of Pennsylvania State Ethics Commission SEC226 REVISED FOR OFFICIAL USE ONLY COMPLAINT completed form to: State Ethics Commission 309 Finance Building P.O. Box 11470 Harrisburg, PA 17108-1470 (717)783-16101-800-932-0936www.ethics.pa. INSTRUCTIONS 226 Please see of this form 1.Identify the Name: Address: PhoneNumber: Phone Number: 3.Attach or make reference to any documents materials which support your allegations. 4. Sworn to and subscribed before me this I swear or affirm, under penalty of perjury, that the facts set forth in this complaint are true and correct to the best of my knowledge and belief. I also swear and affirm that I have read and understand the prohibited retaliation, confidentiality, and rongful se of ct provisions on the form. Signature Print/Type your nameAddress:Phone Number:Phone Number: American LegalNet, Inc. www.FormsWorkFlow.com