11-21  ELIZABETHVILLE BOROUGH P.O. Box 578 Elizabethville, PA 17023 (717) 362-7945 Complaint Form Allr requestedimformation on this form must be complete andl legible.  Complainant Information: Name: Daytime Phone:  Address: Email Address:  Ist the issue outlined within this complaint visible from a public street or area? Yes  No  Ifno, Ihereby give thel Borough's authorized agent permission to enter upon my property to investigate this complaint.  Complainant'ss Signature Address of Complaint: Location of Issue on Property: Date/time issue(s). started: Description of complaint:  Complainant sl Printed Name  Date  Complaint Information: (use separate sheet ifr necessary)  Ist thei issue currently ongoing? Yes! No  Automobile information (fapplicable):  Color  Make  Model  License #  Complainant's! Signature Property Owner Information Owner's1 Name: Owner's Mailing Address: Received by: Date Sent:  Complainant's.P Printed Name  Date  FOR BOROUGH USE ONLY:  Owner's Phone: Date Received:  Sent to: Code Officer Building Code Official Highway Dept  Via: Email Inl Person