C.E.O.

COMPLAINT FORM

TOWN OF ELIOT

1. Date of Complaint: ______________________________________________________________

2. Time of Complaint: ________________________

3. Name of Complainant:____________________________________________________________

4. Complainant Address:____________________________________________________________

5. Telephone Number day: ____________________

6. Describe the nature and location of the complaint: ______________________________________

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I affirm that each of the above statements is true and correct.

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Signature

Official use only:

Complainants Tax Map______ Lot_____ Subject Property Tax Map______ Lot _______

Date received _____________

C.E.O. Signature _____________________________________________

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