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Minimum Housing Complaint Form
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Resident Information
Name
*
Email Address
*
Phone Number
*
Address
*
Violation Information
Date and Time of Violation
*
Date and Time of Violation
Date and Time of Violation
Property Location
*
Exterior Property
Trash, garbage, furniture or accumulation in the yard
Trash, garbage, furniture or accumulation on the greenbelt or sidewalk
Overgrown weeds or vegetation encroaching on the right of way
Parking on grass or in the greenbelt
Unregistered, inoperable or dismantled vehicles
Sign or other obstruction placed in greenbelt or right of way
Dumpster location, maintenance o Dilapidated fences, garages or outbuildings
Other
If other, please describe
Exterior Building
Defective stairs, porches, or roof
Broken or otherwise defective windows or doors
Excessive peeling paint or other dilapidated surfaces
Furniture constructed for indoor use or other accumulations on porch or stairs
Other
If other, please describe
Interior Building
Defects to electrical, heating or plumbing systems
Stairs, handrails, or other egress defects
Smoke or CO detectors inoperative or missing
Over-crowding, illegal living space in cellar or attic
Problems with means of egress
Excessive accumulations or storage
Other unsafe or unsanitary conditions
If other, please describe
Additional Comments
Signature
*
Date
*
Date
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