If you have a specific request for action to be taken by the City, you may submit it through our Complaint Form.

Please complete the entire questionnaire. Please note, if the information you provide is incomplete or the City has questions about your request, we may not be able to fully investigate if we cannot contact you. Once we determine which department should receive you request, it will be entered into our tracking system.

Please Note: (*) indicates required fields.

1

Contact Information

 *

Contact Information

Name

Address

Address 2

City, State, ZIP Code

Email Address

Phone

2

City Employee's Name

 *

City Employee's Name

3

City department where employee works:

City department where employee works:

4

Date of Incident:

 *

Date of Incident:

5

Time of Incident:

 *

Time of Incident:

6

Place of Incident:

 *

Place of Incident:

7

Describe Incident:

 *

Describe Incident:

8

Does an attorney represent you in this matter

Does an attorney represent you in this matter

9

If yes, please give his/her name and address:

If yes, please give his/her name and address:

10

Have you begun any legal action aginst this person or department? If so, please describe:

Have you begun any legal action aginst this person or department? If so, please describe:

11

Are you willing to sign an affidavit or complaint against the person you named if requested:

Are you willing to sign an affidavit or complaint against the person you named if requested:

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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