Fillable ABINGDON CITIZEN COMPLAINT FORM (Town of Abingdon)

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ABINGDON CITIZEN COMPLAINT FORM (Town of Abingdon)

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The ABINGDON CITIZEN COMPLAINT FORM (Town of Abingdon) form is 2 pages long and contains:

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  • 4 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Abingdon

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ABINGDON CITIZEN COMPLAINT FORM
TOWN OF ABINGDON, VIRGINIA
P. O. Box 789 Abingdon, Virginia 24212-0789
General Office Hours: Monday through Friday 8:30 a.m. – 5:00 p.m.
Telephone: (276) 628-3167/ FAX: (276) 698-3328
Web Site http://www.abingdon-va.gov/
1. YOUR NAME:_________________________________________________________________
2. YOUR ADDRESS:______________________________________________________________
______________________________________________________________
3. YOUR DAYTIME PHONE:_____________________________
4. YOUR EVENING PHONE:_____________________________
5. IS THE COMPLAINT REGARDING:
A TOWN POLICY OR PROCEDURE: _____YES
(If so skip to question #10)
A TOWN EMPLOYEE:____YES
(If so, please complete rest of form)
6.DATE OF INCIDENT OR COMPLAINT:______________________________________________
7.TIME OF INCIDENT OR COMPLAINT:______________________________________________
8. LOCATION OF INCIDENT OR COMPLAINT:_________________________________________
9. WHO ELSE MAY HAVE WITNESSED THE INCIDENT?
NAME_________________________________________
MAY WE CONTACT THEM?____YES____NO
10. NATURE OF THE COMPLAINT? (BE SPECIFIC – WHO, WHAT, WHEN, WHERE, HOW.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
11. REMEDY REQUESTED:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
In order for a complaint to be received by the Town, the complainant must sign this form and
submit it to the Office of the Town Clerk at 133 W. Main Street, Abingdon, VA., and
request/obtain an appointment (date & time) to discuss the matter with the Town Manager:
Requested Appt: Date___________ Time______________
SIGNATURE_______________________________________________DATE_________________
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ABINGDON CITIZEN COMPLAINT FORM (Town of Abingdon)

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Completed 18 July 2020

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