2. Complainant's Name*

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4. Address*

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6. City*

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7. State*

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8. Zip Code*

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10. Phone Number

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12. Email Address

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16. Address / Location of Complaint*
18. City*
19. State*
20. Zip Code*
22. Phone Number
24. Code Enforcement Complaint Description*
26. Date
    Date
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28. 1. Receive an email copy of this form.
29. Email address

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30. Submit

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