BENTLEY TOWNSHIP BLIGHT COMPLAINT FORM

DATE: ___________________________

NAME: _________________________________________________________________

ADDRESS: ___________________________________________________________________

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COMPLAINT: _________________________________________________________________

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______________________________________________________________________________

______________________________________________________________________________

NAME OF PERSON MAKING COMPLAINT: ______________________________________

_____________________________________________________________________________

ADDRESS: ___________________________________________________________________

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PHONE: _____________________________________________________________________

SIGNATURE: ________________________________________________________________

THIS FORM MUST BE COMPLETED TO BE A FORMAL COMPLAINT.

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FOR BLIGHT OFFICER

1^ST NOTIFICATION: ___________________________________________________________

2^ND NOTIFICATION: ___________________________________________________________

3^RD NOTIFICATION: ___________________________________________________________

RESOLVED: __________________________________________________________________