Fillable Form 12463 Complaint Form (City of El Mirage)

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Form 12463 Complaint Form (City of El Mirage)

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The Form 12463 Complaint Form (City of El Mirage) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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City of El Mirage
Civil Rights
Complaint Form
Date filed:
Complainant Information Designee Information (if applicable)
Name: Name:
Address: Address:
City: City:
Zip code: Zip code:
Phone: Phone:
Email: Email:
Preferred contact: Preferred contact:
Details of Complaint
Date of incident (must be filed within 180 days of incident):
Location of incident:
City department/employee you spoke with:
Complaint description - Provide a brief summary of the situation regarding the Civil Rights
complaint. Please provide names and detailed information:
Please submit to:
City of El Mirage
Office of the City Clerk
12145 NW Grand Avenue
El Mirage, AZ 85335
Phone: (623) 876-2931
TDD: (623)
Email: santes@cityofelmirage.org
933-3258
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Form 12463 Complaint Form (City of El Mirage)

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Completed 16 July 2020

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