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STATE OF NEVADA
DEPARTMENT OF EMPLOYMENT, TRAINING AND REHABILITATION

EQUAL RIGHTS COMMISSION

INSTRUCTIONS For Completing: Housing Complaint Form

Housing Discrimination Complaint Form

The Nevada Equal Rights Commission is charged with the enforcement of employment, housing and public accommodations, state and federal discrimination laws, under NRS 233 and 613 inclusive; Title VII of the Civil Rights Act of 1964, as amended; Age Discrimination in Employment Act of 1967, as amended; and Equal Employment Opportunity Commission procedural regulations; housing NRS 118 and Public Accommodations NRS 651.

NOTE: Your complaint must be filed within 1 year of the last alleged discriminatory act.

Section A

Section B

Physical Address

Section C

Give the name of someone who can help us reach you.

Physical Address

Section D

Section E

This is a complaint of discrimination based upon:

(Mark only the reasons which you believe caused the discriminatory act(s) that you are claiming.)

Section F

List the name(s) of the individual(s) that you are claiming participated in the alleged discrimination:

Section G

List any witnesses to the alleged discrimination:

Witness 1

Witness 2

Witness 3

Section H

Section I

I swear/affirm under penalty of perjury that the foregoing is true to the best of my information and belief.