Property Maintenance Zoning Complaint

Property Maintenance Zoning Complaint

Village of Galena, 109 Harrison Street, PO Box 386, Galena, Ohio 43021 , 740-965-2484
INSTRUCTIONS: To initiate an investigation, completely fill out this form, sign and date it, and submit to the Village code compliance office at the address listed above. NOTE: Incomplete or unsigned complaints will not be processed.
Name of Complainant:

First NameLast Name
Today's Date:

MonthDayYear
Date
Address of Complainant:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address of the property in this complaint:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupant of the property in this complaint:

First NameLast Name
Date problem was first noticed:

MonthDayYear
Date
Is anyone in danger?:
Nature of the complaint (be specific):
Requested Action:
NOTE: If this matter should go to court, you may be subpoenaed to testify as a witness.
This document is a public record and subject to public records laws of the State of Ohio.
Signature

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Date

MonthDayYear
Date

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