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2. Property Location/Address of Concern*
4. Complaintant Information
6. Name*
8. Phone*
10. Email
12. Mailing Address*
14. Property Owner/Landlord Information
16. Name*
18. Phone
20. Email
22. Mailing Address
24. Complaint Information
26. Date problem(s) began*
    Date problem(s) began
28. Have you contacted the property owner and verbally informed them of your complaint?*

    1. Yes

    1. No
30. Have you contacted the property owner in writing to inform them of your complaint?*

    1. Yes

    1. No
32. What types of problems/concerns are there?*

    Check all that apply

    1. Structural
    2. Electrical

    1. Mechanical/AC
    2. Plumbing

    1. Security/Fire Safety
    2. Other
34. Describe Structural Problems
36. Describe Electrical Problems
38. Describe Mechanical Problems
40. Describe Plumbing Problems
42. Describe Security/Fire Safety Problems
44. Describe Other Problems
46. Photographs are not required but are helpful. You may either upload photos using the fields below or email from your phone to planning@madisonga.com
48. Upload photo 1
50. Upload photo 2
52. Upload photo 3
54. Upload photo 4
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field