Property Condition Nuisance OR Police Related Nuisance
Complaint Form

Date

Name

Address

Phone

Email

Date of problem

The City of Whitewater has already been contacted: YES NO Date:

Description of the problem

Address of the property where the problem occurred

Owner of property

Owner’s phone Owner’s address

Owner contact? YES NO Date of contact

If YES, what result?

Evidence such as photos, logs, or documents? YES NO Description:

Complaint to be submitted to City of Whitewater by HSPNA with complainant’s name.
OR
Complaint to be submitted to City of Whitewater by HSPNA without complainant’s name.

Date_______________________ Signature ________________________________