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) ________________________________________________________________________

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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: ________________________________________________________________________

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Signature of Village Representative                                                    Date