Matanuska-Susitna Borough

MATANUSKA-SUSITNA BOROUGH 350 East Dahlia, Palmer, Alaska 99645 Planning Department Code Compliance Division (907) 745-9853 Facsimile (907) 745-9876 E-mail: [email protected]

COMPLAINT Please fill out completely. Attach additional pages if needed, return to the address listed above. Location of the property where the possible violation exists: (If you don’t know the address, please describe the location and identifying information such as description of buildings or vehicles, license numbers, etc. Please provide a site plan or map if you can) Street address ______Subdivision ______Block ______Lot ______Vicinity ______Township ______Range ______Section ______Meridian______MSB Tax parcel ID # ______Describe the possible violation: ______At what date/time did you first notice the possible violation? ______A.M.__ P.M__? How long has the possible violation existed? ______If known, provide the name, address and telephone number of the owner of the property where the possible violation exists: ______If known, provide the name, address and telephone number of the person causing the violation if that person not the owner of the property: ______Do you have any surveys, photos, video tapes or other documentation of the possible violation that you will provide to the Borough: Yes______No ______if yes, please describe

T_____R_____S_____M__ Tax Parcel______File MSB______MSB Code ______Page 1 of 3

D:\Docs\2018-05-05\0a4aa107b6411e3e09f9aada1ff3547b.doc what you have and provide it with this complaint or let us know when it would be available. ______

D:\Docs\2018-05-05\0a4aa107b6411e3e09f9aada1ff3547b.doc Have you previously filed a complaint about this possible violation? Yes_____ No _____ if yes, when was your last complaint? ______Are you filing an anonymous complaint? Yes ____ No ____, If no please answer the following: Are you willing to provide testimony in court confirming the incident you describe in this complaint? Yes____ No ____ if yes, we will contact you for scheduling, if needed.

Your signature: ______Date: ______Your Name printed: ______Mailing Address: ______Telephone: (work) ______(home) ______(cell) ______

E-mail: ______

Notes: ______

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