Village Grande at English Mill Homeowners Association  
                                   FORM 101 
                       GENERAL COMPLAINT FORM 
            (Complaint may only be filed by members of the Association.  Return the completed form by Email, fax or place in Mailbox 
                                  outside Site Manager’s Office) 
                                           
                                           
          CONTACT INFORMATION FOR ASSOCIATION MEMBER FILING COMPLAINT:  
          Name:                                                                                                    Date complaint filed:                         
                                                              
          Address:                                                                                                Phone number:                                         
                                                           
          Email Address:    
          *FAILURE TO PROVIDE CONTACT INFORMATION WILL RENDER COMPLAINT INVALID. 
          COMPLAINT: 
           As a property owner and member of The Village Grande at English Mill Homeowner’s Association, I do 
          swear and affirm that on or about                           (date of violation), I did witness the following event(s) 
                                 
          or occurrence(s), which I consider to be a violation or nonconformance of the Covenants, Conditions and 
          Restrictions,  By-Laws,  or  any  other  Rules  &  Regulations  of  VGEM  (Please  note  that  the  person 
          submitting a complaint is responsible to review restrictive covenants to determine if event/occurrence is 
          prohibited):   
             
           
             
            
             
             
            
          Address where violation occurred:    
             
          Photos or other documentation included with this complaint:      YES                   NO       
                                                              
          PLEASE NOTE:  Complaint remains anonymous except in the following conditions: 1) Person against  whom 
          complaint is filed requests a hearing with the Board and/or the ADR Committee to respond to the allegations in the 
          complaint; and 2) Person against whom the Complaint was filed pursues legal action against the Association. 
          Please keep a copy of this complaint for your records, as copies of the complaint will not be provided by our office. 
          You will not be contacted in response to this complaint unless further communication is required for enforcement. 
          12-4-2013