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Resident Complaint Form

2. Address of Complaint*
3. Date*
   Date
5. Parcel Number
6. Section
7. Subdivision
9. Property Owner’s Names
11. Property Owner's Address
13. City
14. State
15. Zip Code
17. Complaint*
19. Image of complaint
    Please upload image of complaint.
21. Anonymous Complaints Are NOT Accepted
23. Complaint submitted by*
24. Your Daytime Phone Number*
25. Your Email Address
27. Complaint retraction:
    If you submitted a complaint and you would like to retract it, please email the details to kchaney@liberty-township.com.
29. Your Address*
31. City*
32. State*
33. Zip Code*
37. Action / Inspection
39. Date
    Date
40. By
42. Action / Inspection
44. Date
    Date
45. By
47. Notified

    1. Building Department
    2. Health Department
    3. Sheriff's Office
    4. Soil and Water
49. Building Department Date
    Building Department Date
50. Health Department Date
    Health Department Date
51. Sheriff's Office Date
    Sheriff's Office Date
52. Soil & Water
    Soil & Water
54. This form is subject to examination under the public records information act.
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field