ADA Citizen Complaint Report - City of Williamsport

Citizen Complaint Report

Complaint Process

complete out the form below

or

download and complete the Citizen Complaint Report
return the form to the appropriate department
the department will provide the form to the Mayor’s office immediately for review
the Mayor’s office (or appropriate City representative) will make contact within 24-48 hours to resolve the issue

Department to be Submitted to:

Citizen Information

First Name *

Last Name *

Address *

City *

State *

Zip *

Home Phone *

Alternate Phone

Email *

Grieving Party (if not citizen)

Grieving Party Phone

Grieving Party Email

Complaint Information

Department Involved *

Notification Date *

Complaint Date/Time *

Nature of Complaint (who, what, when, where, etc.) *

Citizen Signature

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