Fillable Americans With Disabilities Act Complaint Form PDF (City of Hialeah)

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Americans With Disabilities Act Complaint Form PDF (City of Hialeah)

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Americans with Disabilities Act Complaint Form
This complaint may be submitted by completing the online form, by mailing the completed form to the
address below, by coming to the Office of the ADA Coordinator or by phone. To obtain this form in an
alternative format, please call 305-883-5814, TTY users may call 711 (Florida Relay Service)
The Office of the ADA Coordinator may contact you to obtain more information in order to process a
complaint.
Mailing address:
Marbelys Fatjo, Esq., City Clerk
ADA Coordinator
City Hall – 501 Palm Avenue, 3rd Floor
Hialeah, FL 33010
Complaint Information:
Personal Information:
First Name:
Last Name:
Address:
Phone:
Alternate Phone:
Email:
Please describe the incident here. Please include any names, dates or locations as may
be necessary. Please explain why you feel you have been discriminated against on the
basis of any disability
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Americans With Disabilities Act Complaint Form PDF (City of Hialeah)

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Completed 16 July 2020

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