Somerville Licensing Commission Complaint Form
Instructions:
The purpose of this form is to allow individuals to file complaints with the Somerville Licensing Commission relative to suspected violations concerning businesses licensed by the commission. To file a complaint, please complete this form and submit it to the City of Somerville Licensing Commission Office.
Name of Licensee:
*
Business Name (d/b/a):
*
Address of Premises:
*
Date of Incident:
*
Time of Incident:
*
Type of Incident:
*
Sale of alcoholic beverages to underage individuals
Purchasing alcoholic beverages from an unauthorized source
Sale of alcoholic beverages to intoxicated individuals
Entertainment without license
Overcrowding
Illegal gambling
Other
Provide detailed information relative to the suspected violation that is the subject of your complaint:
*
Please attach copies of any supporting documentation (i.e. receipts, pictures, advertisements, etc.):
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Name:
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Submit
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