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STATE OF FLORIDA FLORIDA COMMMISSION ON HUMAN RELATIONS PETITION FOR RELIEF

)
Petitioner,	)
vs.	)	FCHR Case No:
)
Respondent	)

Petitioner files this Petition for Relief from a (check the applicable one):
Discriminatory Employment Practice
Discriminatory Housing Practice
Discriminatory Public Accommodation Practice

PETITIONER’S CONTACT INFORMATION:
Name:
Street or PO Box:
City:	State:	Zip Code:
Telephone Number:	Fax Number:
E-mail address:

RESPONDENT’S CONTACT INFORMATION:
Name:
Street or PO Box:
City:	State:	Zip Code:
Telephone Number:	Fax Number:
E-mail address:

RESPONDENT’S REPRESENTATIVE (if any and if known):
Name:
Street or PO Box:
City:	State:	Zip Code:
Telephone Number:	Fax Number:
E-mail address:

WHEN AND HOW DID PETITIONER RECEIVE NOTICE OF THE COMMISSION’S DETERMINATION:

THE FOLLOWING IS A CONCISE STATEMENT OF THE ULTIMATE FACTS ALLEGED, INCLUDING SPECIFIC FACTS PETITIONER CONTENDS WARRANT REVERSAL OR MODIFICATION OF THE COMMISSION’S DETERMINATION:

RESPONDENT HAS VIOLATED THE FOLLOWING FLORIDA STATUTE (Check One):
Florida Civil Rights Act of 1992, as Amended, or
Florida Fair Housing Act, as Amended
THE FOLLOWING IS AN EXPLANATION OF HOW THE ALLEGED FACTS RELATE TO THE SPECIFIC FLORIDA STATUTE

PETITIONER SEEKS THE FOLLOWING RELIEF:

*Note that	(provide #) additional pages have been attached.

WHEREFORE, Petitioner respectfully requests that the Florida Commission on Human Relations enter an Order prohibiting the discriminatory practice and granting affirmative relief, damages, attorneys’ fees and other relief as may be just and equitable in this cause.

Petitioner’s Signature	Date

How-To Guide: (interactive)

TextBookDiscrimination.com/Guides/Petitions/Relief.html

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