Please fill out the form and then click on the "Submit" button.


Violator:

Violator Name:
Violation Address:

Violator City:

State:

Zip:

Violator Phone:

Tax Account #:

(if known)

Details of Complaint:

Please keep in mind the upper portion of this form is public record.

Disclosure Choice:

Under Chapter 42.17.310 (1) (e) R.C.W., the Public Disclosure Law, you as a complainant may indicate a preference for disclosure or non-disclosure of your name to inquiries from the public. If you choose to keep your name confidential, the complainant information will be removed from this form. It should be understood that if this case is filed in court, your name must be disclosed if you are to be a witness in the case.

YES, you MAY disclose my identity upon public inquires regarding this complaint. NO, you MAY NOT disclose my identity upon public inquires regarding this complaint without my permission.

Complainant Information:

Name:
Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Email Address:

Note:

Your Home Phone and Email Address will only be used to clarify complaint details, if necessary.