EmailMe Form - Town of Albion

*

Date Complaint Filed

Person making the complaint info (your name)

Street Address

Telephone#
Email *
How was the complaint filed? *
In Person
By Mail
By Phone
Fax/Email
Is Confidentiality requested (Within the limits of the State Open Record Laws) *
Yes
No
RESPONDENT INFO *

Name(who complaint is registered against)

Street Address

Telephone Number (include area code)

Nature of Complaint/Concern
Signature of person making complaint *
Clear
*

Complaint Forwarded to

Date

A site visit and/or further research conducted on
concluded that
this is not a valid complaint: no further action required
further follow-up is required by the building inspector's office
this complaint falls in the jurisdiction of another department/personnel and will be forwarded to the following:
Department / Personnel

Date
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Date Complaint Filed
Person making the complaint info (your name)
Street Address
Telephone#

Name(who complaint is registered against)
Street Address
Telephone Number (include area code)
Nature of Complaint/Concern

Complaint Forwarded to
Date
A site visit and/or further research conducted on

Department / Personnel
Date