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INCORPORATED VILLAGE OF LINDENHURST (Incorporated Village of Lindenhurst)

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(631) 957-7500
FAX (631) 957-4605
INCORPORATED VILLAGE OF LINDENHURST
430 SO. WELLWOOD AVENUE - LINDENHURST, NEW YORK 11757
RESIDENT COMPLAINT FORM
Please fill out the form below and return it to Lindenhurst Village Hall, 430 South Wellwood Avenue, Lindenhurst, NY
11757. Be sure to include an exact location for the complaint. If you have any questions, please call (631)
957-7500.
Complainant Information:
Complainant Name: ________________________________________________________________________________
Phone Number: _______________________________________ Date: _________________________________
Address: _________________________________________________________________________________________
Complaint Information:
Exact Location of Complaint: ________________________________________________________________________
Owner of Property (if known): ________________________________________________________________________
Owner’s Address (if known): __________________________________________________________________________
Complaint (please give as much information as possible):
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INCORPORATED VILLAGE OF LINDENHURST (Incorporated Village of Lindenhurst)

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Completed 17 July 2020

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