Schwenksville Complaint Form

SCHWENKSVILLE BOROUGH

300 MAIN ST., SCHWENKSVILLE, PA 19473
Request for Code Enforcement Investigation

This form is a public record and will be provided to anyone requesting a copy, including the person alleged to be the source of the complaint
Premises Location*
Owner(s) of Record*
Name of Complainant*
You are hereby requesting that a Borough Official investigate your complaint, occurring at the above noted premises as detailed.
Please provide a written statement of the information as to the specified complaint to be investigated.*
I am willing to testify at District Court, if necessary.*

YesNo
I have independent evidence or photos.*

YesNo
Please attach any evidence you have to assist us in our investigation

Cancelof
Additional witnesses: (provide names, addresses and phone numbers)
I swear that this complaint is true and correct, and understand that false statements made herein are subject to penalties of perjury.
Complainant Name*
Complainant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Complainant Phone Number*
Complainant E-mail*
example@example.com
Date*

MonthDayYear
Date
Investigation conducted by?
Disposition
Borough Case Manager
Should be Empty:

SCHWENKSVILLE BOROUGH