OFFICIAL BLIGHTED PROPERTY ORDINANCE COMPLAINT

*INFORMATION WILL NOT BE MADE PUBLIC IF YOU CHOOSE TO REMAIN ANONYMOUS. INFORMATION IS FOR FOLLOW-UP REASONS ONLY.*
Name of Complainant/Title/Office*
Address/ City/ State/ Zip*
Phone Number*
E-mail Address
Do you want to remain anonymous?*

YESNO
I understand that I may be called to testify in a court of law regarding the above-mentioned matter.

Date

MonthDayYear
Date
I am requesting an investigation regarding a possible violation of the Avoyelles Parish Blighted Property Ordinance located at:
Under the ownership of:
Nature of complaint: (be specific)
Directions to site:
ANY CONCERNS THAT SHOULD BE BROUGHT TO OUR ATTENTION FOR THE SAFETY OF OUR OFFICER?

YESNO
IF YES, PLEASE SPECIFY:
Signature
Should be Empty: