2019 UPUA Elections Violation Form

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This form is to be used by persons who desire the Elections Commission to take action regarding a violation of the UPUA Elections Code of 2019.

Name of Ticket or Candidate *

Location of Violation *

Date of Violation *

YYYY

Time of Violation *

Time

Description of Violation (please include as many details as possible and attach any supporting evidence available) *

Rules Applicable to Violation *

Witness(es) to Violation (please provide as much contact information as possible) *

I hereby submit this report to the UPUA Elections Commission for review and transfer all rights to the information and property contained within to the Elections Commission. I understand that I, any campaign with which I am affiliated, and/or any individual associated with me or this report may be asked to testify or submit further evidence to the Elections Commission and that I have notified all applicable parties as such. I understand that the Elections Commission is not responsible for any damages to me, any campaign with which I am affiliated, and/or any individual associated with me or this report that may result out of the submission of this report. *

I have read and agree to the above statement.

Name of Filer of Report *

Filer Email and Phone Number *

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