City of St. Helens
Complaint Form
Mail or drop off completed form to: City of St. Helens, 265 Strand Street, St. Helens, OR 97051, 503-397-6272
Please print Complete all boxes Use additional paper if needed
Complainant Information
Your Name:
Telephone Number:
Mailing Address:
E-mail Address:
Subject Property Information
Location Address:
Description of Property:
Nature of Complaint
Please explain in detail the subject(s) of your complaint:
(Please use additional paper if necessary)
Would you like a staff person to contact you regarding this issue? No Yes
Complainant Signature:
FOR OFFICE USE ONLY
Staff Follow-up
Staff Member:
Date Received:
Received By: