| Name:___________________________ Contact
Number(s): ( )
Address:__________________________ (
)
Are you a condo unit owner? Yes No
Address / Unit #: ______________________________
What is the name of the condominium?
What is the address of the condominium?
What is the name of the Condominium Association?
What position do you hold regarding this Association? (director, officer, unit owner, etc…)
Association Board of Directors:
Names and contact numbers
President:
(
)
Vice President:
(
)
Secretary:
(
)
Treasurer:
(
)
Does the Condominium have a community association manager?
Yes
No
Name/contact number:
( )
Have you brought your complaint to the Board of Directors?
Yes
No
If so, when, where, and what was their response?
Have you submitted a Condominium / Cooperative Complaint Form to the Department of Business and Professional Regulation, Division of Land Sales, Condominiums and Mobile Homes
(DBPR)?
YES No
If so, please enclose a copy of the complaint and answer the following questions:
Name and contact number of DBPR Representative(s):
( )
( )
What is the status of the complaint filed with DBPR?
Have you previously contacted the Ombudsman?
Yes
No
What is the name of the person you feel is responsible for the alleged financial wrongdoing? If they are a condominium officer, please include their position.
Have you made a request pursuant to Florida State Statute 718.111(15)(c) to inspect the records?
YES
No
Have your reviewed the financial records of the condominium to identify evidence of financial wrongdoing?
YES
No
What was the result of your review / request?
Please list any evidence of what you believe to be any financial wrongdoing? (checks, contracts, invoices, receipts, bank records, etc…)
Please list any witness who can provide evidence of the financial wrongdoing. List names, contact information and the substance of their knowledge.
Has any audit or accounting been done to confirm these allegations? If so, please include a copy of the financial statements.
YES
No
Please do not submit this form until you have sufficient documentation to support your allegations. Do not expect immediate results. Investigations are complicated and take time to facilitate. Thank you for your patience.
PLEASE
COPY AND PASTE THIS FORM INTO YOUR WORD PROGRAM FOR PRINTOUT! |
