"Voluntary Withdrawal Request Form" - Illinois

Voluntary Withdrawal Request Form is a legal document that was released by the Illinois Department of Human Rights - a government authority operating within Illinois.

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Download "Voluntary Withdrawal Request Form" - Illinois

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Bruce Rauner, Governor
Janice Glenn, Acting Director
VOLUNTARY WITHDRAWAL REQUEST FORM
RESPONDENT:
COMPLAINANT:
I hereby request to withdrawal my charge filed against the above named Respondent(s) with the
Illinois Department of Human Rights ( Charge No.
) and the U.S.
Department of Housing and Urban Development ( Charge No.
).
The reason for my withdrawal is:
Withdrawal is being made of my own free will, without pressure or fear of retaliation from any
organization or individual. I understand that if I am withdrawing this charge because I have
reached a settlement with the Respondent outside of the Department, which has not been signed
by the Department and approved by the Human Rights Commission, those agencies cannot
enforce that settlement.
I understand that I may re-file my charge if the terms of the settlement are not satisfied and where
the discriminatory housing practice is timely according to state and federal law.
I further understand that the execution of this form will terminate the Department of Human Rights'
processing of this case.
Signature
Date
#6Hsg
100 West Randolph Street, Suite 10-100, Chicago, IL 60601, (312) 814-6200, TTY (866) 740-3953, Housing Line (800) 662-3942
222 South College Street, Room 101, Springfield, IL 62704, (217) 785-5100
2309 West Main Street, Marion, IL 62959 (618) 993-7463
www.illinois.gov/dhr
Bruce Rauner, Governor
Janice Glenn, Acting Director
VOLUNTARY WITHDRAWAL REQUEST FORM
RESPONDENT:
COMPLAINANT:
I hereby request to withdrawal my charge filed against the above named Respondent(s) with the
Illinois Department of Human Rights ( Charge No.
) and the U.S.
Department of Housing and Urban Development ( Charge No.
).
The reason for my withdrawal is:
Withdrawal is being made of my own free will, without pressure or fear of retaliation from any
organization or individual. I understand that if I am withdrawing this charge because I have
reached a settlement with the Respondent outside of the Department, which has not been signed
by the Department and approved by the Human Rights Commission, those agencies cannot
enforce that settlement.
I understand that I may re-file my charge if the terms of the settlement are not satisfied and where
the discriminatory housing practice is timely according to state and federal law.
I further understand that the execution of this form will terminate the Department of Human Rights'
processing of this case.
Signature
Date
#6Hsg
100 West Randolph Street, Suite 10-100, Chicago, IL 60601, (312) 814-6200, TTY (866) 740-3953, Housing Line (800) 662-3942
222 South College Street, Room 101, Springfield, IL 62704, (217) 785-5100
2309 West Main Street, Marion, IL 62959 (618) 993-7463
www.illinois.gov/dhr