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2. Nature of Complaint - Please Mark All That Apply:*

   1. Dumping
   2. Building without a permit
   3. Unregistered / Inoperable Vehicles (Please list how many)
   4. Other
4. If Other, please explain:*
6. General Location:*
8. Property Address:*
10. Owner/Occupant:
12. Complainant Name:*
14. Mailing Address:
15. City:
17. State:
18. Zip:
20. Daytime Phone:
22. Email Address:*
24. Remain Anonymous?*

    1. Yes
    2. No

26. Zoning Enforcement Officer Verification
    (for office use only)
    

    Owner:___________________________________________          S-T-R: ___________
    
    Mailing Address:_________________________________________  Zoning: __________
    
    City, State, Zip: _____________________________________  Township: __________

    Appraiser PID#: ____-____-____-___-___-______.______

    Lot: _________ Subdivision: ________________________________

    Inspection Date: ____________________
    

    Violation Exists?  _____Yes    _____No        Violation #: ______________

    Remarks: _____________________________________________________________________
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field