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2. Purpose

   This form is used to communicate with village personnel to report violations of the village codes and ordinances. All information reported here is confidential. We request your name and contact information so that we can update you with the results of the investigation into the complaint.

   Warning! Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 911.

4. First Name*
5. Last Name*
7. Business Name
8. Email Address
10. Daytime Phone*
11. Fax Number
13. Address*
15. City*
16. State*
17. Zip Code*
19. Nature of the Complaint*
21. Date & Time*
    Date & Time

    Date & Time
23. Method of Contact

    How would you like us to contact you with the results of our investigation?

    1. Daytime Phone Number
    2. Email (please provide in address from)
    3. Mail
    4. No Response Necessary
25. Attach Picture or File
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field