Constituent Grievance Form
Date:____________________
Name: ________________________________________
Address: _______________________________________
Phone: ________________________________________
Email:_________________________________________
Nature of Complaint:
Parking: Street Sweeping: Other: ______________
Trash Pick-Up: Plowing/Sanding:
Pot Hole: Street/Sidewalk:
Department Involved:
Fire: Parks: Schools:
Health: Planning: Treasurer:
Human Resources: Police: Other: ____________
Mayor’s Office: Public Works:
Brief Description of Grievance:
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ATOURIGNY@FITCHBURGMA.GOV
Please save as a document and email completed form to: atourigny@fitchburgma.gov and jdavid@fitchburgma.gov