City of Hartford

Please complete the following information so that the City can investigate your complaint. This form may also be printed and turned into the Clerk upon completion.

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Date *

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Your Name *

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Address *

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a date, Nature

Phone *

If requested, will you attend a City Council meeting to explain your complaint? *

• Yes
• No

Nature of Complaint: (include the date, time, place, and facts of your complaint) *

Should a citation be issued, you may be required to testify to the above complaint in a Court of Law. Do you agree to so testify? *

• Yes
• No

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