Ordinance Violation (or) Complaint Form

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Person Filing Complaint

First Name *

Last Name *

Information About Violation

Town Ordinance Violation # *

Date of Ordinance Violation/Complaint Occurred *

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Name of Person Violation or Complaint is Against *

Description of Violation or Complaint *

TERMS OF ACCEPTANCE and SIGNATURE

I, the submitter of this Violation or Complaint, warrant the truthfulness of the information provided in this application.

Signature *

Please type your First and Last Name

Acknowledgement *

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Acknowledgment Box must be selected

Contact Information