VILLAGE OF WAVERLY
VILLAGE OF WAVERLY
COMPLAINT FORM
Location ____________________________________ Date_________________
Nature of Complaint
| | |Insect or Rodent Harborage |
| | |Refuse and/or garbage on property |
| | |Unsafe Sidewalks |
| | |Weed and Tall Grass Accumulation |
| | |Unsafe Pothole |
| | |Snow and/ or Ice accumulation on Sidewalks |
| | |Unsafe Building |
| | |Dangerous Tree |
| | |Unlicensed Vehicle |
| | |Cemetery |
| | |Other _______________________________________________________ |
Comments:______________________________________________________________
________________________________________________________________________
Name of Complainant _____________________________________
Address _____________________________________
Phone # ______________________________________
For Village Use
Referred To: _____________________________ Date: __________________
By: _____________________________________
Action Taken____________________________________________________________
_______________________________________________________________________
________________________________________________________________________
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