Code Enforcement Complaint Form

Instructions: Please fill in both pages to the best of your ability. It is important that you supply as much detail as possible. If you have any questions, please call the Building/Code Enforcement Office at 585-637-5300 ext 114.

Questions marked with a * are required.

Address of the Violation(s)*

Do you wish that this complaint be anonymous?* Yes No

Details of the Complaint (be specific)*

Are there any known or suspected hazards at this location? (I.e. dangerous or unstable residents, dogs, criminal activity, etc.)* Yes No Uncertain

If yes, please identify the hazard in detail

Complainant Information

Name*

Address*

City*

State*

Zip*

Daytime Phone Number*

Can the violation be seen from the Village Right of Way* Yes No

If not, what is the best vantage point?

Is the complaint about a neighbor?* Yes No

Do you grant the Code Enforcement Officer permission to enter upon your property for viewing the violation?* Yes No

If not, why?

Will you, the complainant, testify in court, should the need arise?* Yes No

Photos and Documentation

If you have photos, or other related information, that can be used as evidence of this violation, please submit them with this form. The submitted documentation will become part of the complaint file.

Photo/File 1

Photo/File 2

Photo/File 3

Photo/File 4

Photo/File 5

Photo/File 6

Photo/File 7

Photo/File 8

Photo/File 9

Photo/File 10

Agreement and Signature

By checking here and entering my name below, I declare, under penalty of perjury, that all information submitted on and with this form is true and accurate to the best of my knowledge.*

Signature (enter your name)*

Thank you for your submission. Your complaint will be reviewed by a Code Enforcement Officer and you will be contacted within 5 business days.