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2. This form must be filled out in order for us to have legal access to the property in question to investigate the complaint. The complaint filed must be deemed a public safety issue or health hazard, i.e. food-borne illness, housing, etc.

   Please note: This complaint will not be pursued unless complainant completes and signs below.

4. Date*
   Date
6. Informant Contact Information
8. First Name*
9. Last Name*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Email
18. Phone*
22. Location of Alleged Violation
24. Address*
26. City*
27. State*
28. Zip Code*
30. Owner's Name
32. Owner's Address (If Different from Location of Violation)
34. City
35. State
36. Zip Code
38. Owner's Phone (If Known)
42. Describe in detail the nature of the complaint.
44. Description*
46. Please list the steps you've taken to rectify the complaint.

    Letter to the owner, etc. Upload any relevant documents below.

48. Description*
50. Upload Photographs or Other Documentation
54. Signature of Informant*
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field