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2. Full Name

   Please provide your name so we can contact you. This information will not be used for any other purposes or shared with anyone other than City staff.

3. Preferred Method for City to Contact You
   -- Select One --PhoneEmail

   Please provide this in case we need to follow up with you on the complaint for additional information or confirmation the issue has been resolved.

5. You Phone Number

   Please provide your phone number so we can contact you. This information will not be used for any other purposes or shared with anyone other than City staff.

7. Your Email Address

   Please provide your email so we can contact you. This information will not be used for any other purposes or shared with anyone other than City staff.

9. Full Address Including Unit #*
   The address, including unit # (if the issue is in a unit), must be provided so that we can ensure the issue is resolved in the correct unit. You do not need to enter the City or State
11. Health, Safety, or Maintenance Issue*
    Please describe in detail the issue in need of repair.
13. A staff member from the Multi-Family Inspection Program will notify your landlord of any required actions or repairs they must make. After repairs are made, the City will contact you to confirm the issues have been resolved.
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15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

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