Forms • Floyd County, IA • CivicEngage

Health/Nuisance Complaint Form

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Property Where Violation Exist:

Address: *

(Owner) First and Last Name:*

Home Phone if know:

General Property Location:

Section:

Township:

Range:

Township Name:

Complainant Information:

Name: *

Address:*

Phone Number:*

Violation Information:

Conditions:*

Date Last Observed:*

No - I do not wish that this information be made public record:
Yes - the information I have provided may be considered public record: *

Yes

by checking yes I am aware the information provided on this form may be viewed by anyone upon request.

Today's Date: *

* indicates required fields.