City Of Jefferson Ada Complaint Form Page 2

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II. PERSONS NAMED IN YOUR COMPLAINT. List the names of all persons involved in your
complaint. Indicate the job title(s) and city department(s) if possible.
III. WITNESSES TO YOUR COMPLAINT. List the names of all persons involved in your complaint.
Indicate the job title(s) and city department(s) if possible.
IV. EVIDENCE AND DOCUMENTATION. List and provide any physical evidence, written or
recorded document, or any other information that directly supports your specific claim of discrimination.

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