Note: Items marked with an * are required and must be filled in to submit your complaint.

Your name:  *

Your street address:  *

Your city:  *,

Your state:    Kentucky District of Columbia Alabama Alaska Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Illinois Indiana Iowa Kansas Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Your Zip code:  *

Your phone: ()  *

E-mail:  *

Type of problem (please select one):

  Food safety Health nuisance Mosquitoes in standing water Sewage discharge *

Name of owner/establishment creating problem:  *

Street Address:  * (If exact address is unknown, please provide a detailed description of the location)

City:  * County:   Boone Campbell Kenton Grant  

Phone: ()  

Nature of problem:

 *