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2. Date
   Date
3. Filed By
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
15. Location of Violation/Complaint
17. Property Owner
19. Address
21. City
22. State
23. Zip Code
25. Phone Number
27. Description of Violation/Complaint
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35. 1. Receive an email copy of this form.
36. Email address

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37. Submit Submit and Print

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