NEIGHBORHOOD COMMITTEE OF ARCHITECTURE

 Complaint Form - Confidential
(Anonymous complaints not accepted)

 Date: _____________________

 Person initiating complaint:

 Name: __________________________________________________________________

Address: ________________________________________________________________

Telephone:______________________________________________________________

Plat _________________Block _________________Lot____________________

 Person against whom complaint is being made:

 Name: _________________________________________________________________

Address: ________________________________________________________________

Plat _________________Block _________________Lot____________________

Complaint: (Attach photo or e-mail a digital photo to )

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________ 

Signed:_________________________________________________________________

 Date:______________________________________