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2. First Name*
3. Last Name*
5. Phone Number*
6. Email Address*
8. Address
10. City
11. State
12. Zip Code
14. Would you prefer to remain anonymous?*

    1. Yes
    2. No
15. If necessary, may we have permission to enter your property to view the alleged violation?*

    1. Yes (We cannot protect anonymity)
    2. No
19. Address of the Violation
21. City
22. State
23. Zip Code
25. If no address is available, provide a detailed description of the location:
27. Property Owner (If Known)
29. Occupants of Property (If Known)
31. Nature of Complaint*
33. Please understand, if our inspectors/officers cannot observe the violation, obtaining compliance becomes more difficult. Include any pictures of alleged violations if they occur after normal business hours.
35. File Upload 1
36. File Upload 2
37. File Upload 3
38. File Upload 4
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40. 1. Receive an email copy of this form.
41. Email address

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42. Submit

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