Association Complaint Form (Page 3 of 3) in pdf

KINGS PARK WEST COMMUNITY ASSOCIATION

P.O. Box 271, Fairfax, VA 22038

ASSOCIATION COMPLAINT FORM

Pursuant to Chapter 29 of Title 55 of the Code of Virginia, the Board of Directors (Board) of the Kings

Park West Community Association (Association) has established this complaint form for use by persons who

wish to file written complaints with the Association regarding the action, inaction or decision by the governing

board, management company or association inconsistent with applicable laws or regulations.

Legibly describe your complaint in the area provided below, as well as the requested action or

resolution of the issues described in the complaint. Please include references to the specific facts and

circumstances at issue and the provisions of Virginia laws and regulations (if any) that support your complaint.

If there is insufficient space, please attach a separate sheet of paper to this complaint form. Also, attach any

supporting documents, correspondence and other materials related to your complaint.

__________________________________________________________________________________

Sign, date, and print your name and address below and send this completed form to the Association at the

address on the letterhead or as an E-mail attachment to the Association at

________________________

___________________________

______________________

Printed Name

Signature

Date

__________________________________________________________________________________________

Mailing Address

__________________________________________________________________________________________

Lot/Unit Address

___________________

Contact Preference

Phone

E-mail

E-mail Address

Phone Number

Other __________

If, after the Board’s consideration and review of your complaint, the Board issues a final decision

adverse to the complaint, you have the right to file a Notice of Final Adverse Decision with the Virginia

Common Interest Community Board (CICB) in accordance with the regulations promulgated by the CICB. The

notice shall be filed within 30 days of the date of the final adverse decision, shall be in writing on forms

provided by the Office of the Common Interest Community Ombudsman (Ombudsman), shall include copies of

any supporting documents, correspondence and other materials related to the decision, and shall be accompanied

by a $25 filing fee. The Ombudsman may be contacted at:

Office of the Common Interest Community Ombudsman

Department of Professional and Occupational Regulation

9960 Maryland Drive, Suite 400

Richmond, VA 23233

(804) 367-2941

CICOmbudsman@dpor.virginia.gov

Association Complaint Form Page 3

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