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Complaint Form - editable VILLAGE OF ALSIP rd 4500 W. 123 Street OMPLAINT REPORT Nature of Complaint: (Attach any supporting info)(Photos)_______________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Location of Complaint:____________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Complaint Taken by:_____________________________________________________________________________ Date of Complaint:______________________________________________________________________________ Complaint received by: _____ Email____ Phone_____ Letter ______ Personal Appearance___ Name of complainant: ___________________________________________________________________________ Address of complainant:__________________________________________________________________________ Phone number of complainant:____________________________________________________________________ Email of complainant: ___________________________________________________________________________ Signature of Complainant:________________________________________________________________________ ============================================================================================ == Date received:______/_____/____ DEPARTMENT USEONLY Complainant given to : ______________________________________________________ ACTION TAKEN: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Signed:______________________________________________ NOTE: Action must be taken and report given to Bldg. Comm and complainant within 36 hrs after receipt in Bldg Dept. Continuation Page: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________