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VILLAGE OF NASHVILLE COMPLAINT FORM
Instructions: Please type or print clearly
Date of Complaint: __________________
Complaint filed by:
Name: ______________________________________________________________
Address: ____________________________________________________________
Phone#: _____________________________________________________________
Your complaint is about: (Please be specific – include person’s name/address -
village department/employees name as applicable)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
How would you like to see this complaint resolved:
___________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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ACTION TAKEN BY VILLAGE REPRESENTATIVE
Referred to: Clerk / DPW / Police / President / Council / Planning / Zoning /
Zoning Administrator (circle one)
Resolution – Complainant contacted: By letter__ By phone __ In person __ Date of
contact _________________
Action taken:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
________________________________
________________________
Signature of Village Representative
Date
The person resolving the complaint must contact the person filing the complaint
with a resolution (in person/by phone or letter) and a copy of the signed and
completed complaint must be filed with the Village Clerk.
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VILLAGE
OF NASHVILLE, MICHIGAN
