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2. Per Florida Statute 162, anonymous complaints will not be processed. The complainant must provide valid name and address (phone number and email optional) below for the complaint to be valid.

4. Date
   Date

   Date
6. Reported By
8. Name
9. Address
10. Phone
12. Property in Violation
14. Property Address
15. Directions
17. Specific Description of Complaint / Comments or Remarks
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field