Citizen Complaint Form

Name __________________Date _____________________________

Address ____________________________________________

Date of Incident _____________E-Mail Address _____________________

Telephone Number Home: (____)_________________Work/Cell:(____)___________

Nature of Complaint: (Please describe fully and in complete detail. Include dates, times, and witness names, as applicable.)

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(Use additional sheets if needed.)

Complaint forwarded to:

___ VILLAGE MANAGER
___ POLICE DEPARTMENT
___ FIRE DEPARTMENT
___ PUBLIC WORKS DEPARTMENT
___ CODE ENFORCEMENT DEPARTMENT
___ PARKS AND RECREATION DEPARTMENT
___ WUPC TV 4 STUDIO
___ INFORMATION TECHNOLOGY DEPARTMENT
___ UNIVERSITY GOLF AND CONFERENCE CENTER

Date ___________________________

Complaint Investigated by _________________________________________

Date Investigation Started ________________________

Results of Investigation ____________________________________________

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Date Investigation Completed __________________________

Complaint Founded _____________ Complaint Unfounded _____________

Complainant Notified Via Telephone ______ Mail ______ In Person ____
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Village Manager