Free Election Complaint Form - West Virginia

Natalie E. Tennant Secretary of State Building 1, Suite 157-K 1900 Kanawha Blvd., East Charleston, WV 25305-0770

ELECTION COMPLAINT FORM State of West Virginia Secretary of State's Office
Telephone: (304) 558-6000 Toll Free: 1-877-FRAUD-WV FAX: (304) 558-0900 www.wvsos.com

Today's date: Name(s) of person(s) making complaint: Contact information (address, daytime phone #, times to call, etc.):

Date(s) alleged event(s) occurred: Person(s) allegations are against: Elected office being sought (if applicable): Description of allegations (if further description is needed beyond the capacity of this form, please attach additional pages as needed): _____________________________________________________________________ Position (if applicable):

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I acknowledge that all of the above information is true and accurately reflects the matter in question, to the best of my knowledge: STATE OF WEST VIRGINIA COUNTY OF The foregoing instrument was acknowledged before me this My commission expires (Notary Public) by .