Fillable CITY OF BLOOMINGTON RENTAL COMPLAINT FORM COMPLAINANT INFORMATION (State of Indiana)

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CITY OF BLOOMINGTON RENTAL COMPLAINT FORM COMPLAINANT INFORMATION (State of Indiana)

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File type: PDF

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CITY OF BLOOMINGTON
RENTAL COMPLAINT FORM
HOUSING & NEIGHBORHOOD DEVELOPMENT
P.O. BOX 100
BLOOMINGTON, IN 47401
PHONE: (812) 349-3420 FAX: (812) 349-3582
EMAIL: hand@bloomington.in.gov
ADDRESS OR LOCATION OF THE COMPLAINT: ______________________________________________
COMPLAINANT INFORMATION
NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
NATURE OF THE PROBLEM
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
HOW LONG HAS THE PROBLEM EXISTED: __________________________________________________________
WHEN DID YOU NOTIFY THE OWNER/AGENT: ______________________________________________________
HOW DID YOU NOTIFY THE OWNER/AGENT: ☐ IN PERSON ☐ IN WRITING ☐ BY PHONE
COMPLAINANT SIGNATURE: ______________________________________________________________________
OFFICE USE ONLY
OWNER’S NAME:
ADDRESS:
NEIGHBORHOOD COMPLIANCE OFFICER:
HOUSING CODE FILE: ☐ YES ☐ NO
CITY LIMITS: ☐ YES ☐ NO 2 MILE FRINGE: ☐ YES ☐ NO
COMPLAINT RECEIVED BY: _________________________ DATE: _____________ TIME: ___________
COMMENTS: _____________________________________________________________________________
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CITY OF BLOOMINGTON RENTAL COMPLAINT FORM COMPLAINANT INFORMATION (State of Indiana)

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Completed 13 August 2021

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