UCC CODE OFFICIAL COMPLAINT FORM

Type or print all requested information clearly. Note that all of the information on this form may be subject to public disclosure by way of a court order.

Complaint Filed By

Address
MM slash DD slash YYYY

COMPLAINT FILED AGAINST:

Address
Address

Provide the following information regarding the building or structure that is the subject of the complaint you are filing:

Check which of the following applies:
Provide the following information regarding the building or structure that is the subject of the complaint you are filing:
Address

Complaint Allegations:

State as specifically as possible the allegations you are making against the code official named above. Do not merely indicate “See attachments”, expecting that the Department will be able to determine the substance of your allegations by reviewing any attachments. However, you may attach information that will substantiate your allegations. If more space is needed, attach additional 8-½” x 11” pages.