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2. First Name
3. Last Name
5. Email
7. Address
9. Home Phone Number
11. Work Phone Number
13. Address of Complaint Property*
15. Name of Owner or Resident of Complaint Property (if known)
17. Check the Type of Violation*

    1. Appliances
    2. Auto Parts
    3. Deteriorating Landscape
    4. Drainage
    5. Excessive Litter or Debris
    6. Fence (dilapidated or debris)

    1. Graffiti
    2. Grass/Weeds (over 12")
    3. Home Occupation (Home Business)
    4. Obstruction of Sidewalk
    5. Unsecure Swimming Pool
    6. Other (list below)
19. Additional Information
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field