Concerned Citizen Rental Complaints

Tenant/ Complainant Name*

Complainant Phone Number*

Phone

Tenant Email Address*

Desired Date of Inspection*

Address Number*

Address Street Name*

Address Zip Code

Property Type

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Landlord Name

Landlord Phone

Phone

Landlord Email

Landlord Address

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Any additional comments?

3rd Party Agency or Housing Counselor submitting on behalf of tenant

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