Complaint Form

2. Complainant's Name*

   *Required

4. Address*

   *Required
   
   

6. City*

   *Required
   
   

7. State*

   *Required
   
   

8. Zip Code*

   *Required
   
   

10. Phone Number

    *Please leave a number if you would like to be contacted
    
    

12. Email Address

    *Please leave a email address if you would like to be contacted
    
    
    

16. Address / Location of Complaint*
18. City*
19. State*
20. Zip Code*
22. Phone Number
24. Code Enforcement Complaint Description*
26. Date
    Date
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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