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2. Date & Time of Complaint*
   Date & Time of Complaint

   Date & Time of Complaint
3. Location of Complaint*
5. Name of Complainant

   (not required)

6. Complainant Contact Information

   (not required)

8. Owner of Property
9. Block Number*
10. Lot Number*
12. Brief Description of Complaint
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14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

* indicates a required field