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Violation Complaint Form
Leave This Blank:
Date Complaint Observed:
Address of Complaint:
What type of problem has been observed?
Owner of complaint property (if known):
Owner of complaint property address:
Owner of complaint property phone number (if known):
Citizen's name observing complaint:
Citizen's digital signature (The foregoing information I am submitting is true to the best of my knowledge.)
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
(checkbox) I agree. Electronic Signature
"First M. Last"
Do you wish your information to remain confidential?
Citizen's phone number:
Citizen's email address:
If the potential violation goes to court, would you be willing to testify?
* indicates required fields.
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