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2. Resident Information
4. Name*
5. Email Address*
6. Phone Number*
8. Address*
10. Violation Information
12. Date and Time of Violation*
    Date and Time of Violation

    Date and Time of Violation
13. Property Location*
15. Exterior Property

    1. Trash, garbage, furniture or accumulation in the yard
    2. Trash, garbage, furniture or accumulation on the greenbelt or sidewalk
    3. Overgrown weeds or vegetation encroaching on the right of way
    4. Parking on grass or in the greenbelt
    5. Unregistered, inoperable or dismantled vehicles
    6. Sign or other obstruction placed in greenbelt or right of way
    7. Dumpster location, maintenance o Dilapidated fences, garages or outbuildings
    8. Other
17. If other, please describe
19. Exterior Building

    1. Defective stairs, porches, or roof
    2. Broken or otherwise defective windows or doors
    3. Excessive peeling paint or other dilapidated surfaces
    4. Furniture constructed for indoor use or other accumulations on porch or stairs
    5. Other
21. If other, please describe
23. Interior Building

    1. Defects to electrical, heating or plumbing systems
    2. Stairs, handrails, or other egress defects
    3. Smoke or CO detectors inoperative or missing
    4. Over-crowding, illegal living space in cellar or attic
    5. Problems with means of egress
    6. Excessive accumulations or storage
    7. Other unsafe or unsanitary conditions
25. If other, please describe
27. Additional Comments
29. Signature*
30. Date*
    Date
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