REFERRAL OF NONCOMPLIANCE

To Board of Andover Glen Homeowners Association

I would like to refer the following issue of noncompliance with the coveants of Anover Glen to the Board for resolution.

Specific Issue:

Dates and Times of Issue, as appropriate:

Covenant section, paragraph, and text at issue:

Noncomplying Homeowner’s Name:

Noncomplying Homeowner’s Address:

Referrer’s name:

Referrer’s address:

Referrer’s phone number:

Referrer’s signature _____________________________________________________

Date: ________________________