Complaint Form

Today's Date(Required)

Enter Today's Date

CONTACT Information(Required)

Name of Person Completing this Form Street Address City State ZIP Code

Contact address, phone and/or email for follow-up from Township Official (Exempt from public disclosure)

CONTACT Phone(Required)

(Exempt from public disclosure)

CONTACT Email(Required)

(Exempt from public disclosure)

COMPLAINT Information(Required)

Property Owner / Name of Resident or Party Responsible Street Address or Location of Complaint State ZIP Code

Known address or location of complaint or area of concern to be investigated by Township Official

Type of COMPLAINT(Required)

Zoning Violation

Blight

Road Problem

Drainage Problem

Other

If "Other" Please Clarify

Nature of COMPLAINT:(Required)

Describe current area of concern or occurrence of possible violation for Township Official to investigate

OFFICE USE ONLY: Signature / Date / Time Received:

CAPTCHA

Riley Township