Elections Complaint Form

For office use only••••

Complaint ID: __ __ __ - __ __ - __ __ - __ __ __ __You may use this form to file a complaint alleging a violation of Colorado Election Law.
All fields marked with an asterisk (*) are required.
This form does not need to be notarized.
Mail, fax, deliver, or scan your signed form and email it to:Date Stamp:

The Colorado Secretary of State, Elections Division
1700 Broadway, Ste. 200
Denver, CO 80290
Fax: (303) 869-4861
state.electiondivision@sos.state.co.us

Secretary of State authorityThe Secretary of State has independent authority to inspect and review the practices and procedures of county clerk and recorders, their employees, and otherelection officials in the conduct of primary, general, and congressional vacancy elections and the registration of electors in this state, with or without the filing ofa complaint by any person. [Section 1-1-107(2)(b), C.R.S.]
NOTICE: This complaint is not confidential and, once filed with the Department of State, will be treated as a public record.

Your identifying information
Last name*Phone number (include area code)*First name*Middle name

Email address

Current Street address (No P.O. Boxes)*

Apt. or Unit

City or Town*

ZIP Code*

Colorado County

Mailing address (required if different from your home address)

Apt. or Unit

City or Town

StateZIP CodeIdentifying information of the person or entity you are alleging the complaint against (only one person/entity per form)
Name of the person or entity*

Phone number (include area code)

Email address

Address

Apt. or Unit

City or Town

StateZIP Code

Alleged violation(s) of State Law (check all that apply)
I was not allowed to:
Vote in secret
Turn in my absentee ballot
Ask questions or ask for assistance
Vote, even though I was standing in line before the polls closed
Re-vote after I made a mistakeState law was violated because:
My voter registration information was altered
My polling place was not open (either on time or at all)
Officials neglected to perform their duties

Other (please specify including statutory provision):

Secretary of State Approved 07-12-2019

I was not able to vote because I wasn't given assistance:
To accommodate my disability
In my own language
I was not provided:
Election materials in my own language
I observed:
Pollworkers acting or saying something inappropriate
Inappropriate electioneering or campaigning too close to the polls
The casting of a fraudulent vote

Details of the complaint
State in your own words the detailed facts and circumstances that form the basis of your complaint, including any relevant person(s). Please
include relevant dates and times and the names and addresses of other persons whom you believe have knowledge of the facts. Also, give any
reasons that you feel the alleged violation was committed by the person and/or entity against whom this complaint is brought.
Please provide the details of your complaint in the space provided below. If you need additional space, attach a separate page or pages.
(please type or print)

Sign or mark below
I affirm that the information provided in this complaint is true and accurate to my best knowledge.

Signature*(date)