Town of Hartford
COMPLIMENT / COMPLAINT / SUGGESTION FORM
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COMPLIMENT
COMPLAINT
SUGGESTION
Your Name:
Address:
Telephone No.:
Format: (000) 000-0000.
Email:
example@example.com
Compliment/Complaint/Suggestions (Include nature and location): continue on back if needed.
Signature of Complainant:
Do you request a response?
Yes
No
How would like to receive your response? Please be sure to include your contact information above.
Email
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Day
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Time
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Received by:
How reported
In writing
In person
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Email
The original will be filed at the town office. Copies to be shared with Board of Selectmen
Complaint or Concern forwarded to:
Forwarded by:
Mail
email
faxed
in person
Date Forwarded:
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Month
-
Day
Year
Date
Time
Hour Minutes
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PM
AM/PM Option
Initials
Action taken by Official
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