CITIZENS COMPLAINT FORM
Regarding Problems Associated with
Abandoned and Dilapidated Properties
in Brownstown, Indiana
The following information must be submitted before a complaint will be accepted and investigated.
1. Complainant Information
a. Name, Address, Telephone Number
2. Property Owner Information
a. Name and Mailing Address of Property Owner(s)
3. Property Information
a. Location of Property (Street Address, Town)
b. Tax District, Tax Map, and Tax Parcel Number (Tax ID Information)
4. Pictures of subject property, with description of the hazard(s) that exist.
5. Signed and Dated Complaint Form
CITIZENS COMPLAINT FORM
1. Citizen Making Complaint
Name:
Address:
Telephone:
2. Name and Address of Property Owner(s)
Name:
Address:
3. Location of Property
Physical Street Address:
Tax ID Information: Tax District: Tax Map:
Tax Parcel(s):
4. Describe the scope and nature of any hazardous conditions on this property which threatens the public health, safety, and welfare of the community.
5. Signature of Complainant:
6. Signature Date:
Return This Form To: Brownstown Development Department
c/o Clerk-Treasurer, Town of Brownstown
200 West Walnut Street
Brownstown, IN 47220
(2011 Code, Ch. 98, App. A)