Housing Court Complaint Form

Question Title

* 1. Contact

Name

Block Club

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Date

Date / Time

Date

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* 3. Address of Problem

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* 4. Docket Number (if known)

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* 5. Property Owner (if known)

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* 6. Liasion (if known)

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* 7. Block Club

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* 8. Occupancy Issues (Vacant, squatters, owner-occupied, etc.)

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* 9. Community Impact (Duration of problem, evidence of criminal activity, proximity to schools, etc.)

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* 10. Block Club's / Neighborhood's Plans for Actions (potential for donation or transfer, need for an interior inspection, orders to vacate, etc.)

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* 11. Property Progress Since Last Court Date

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* 12. Anything Else We Should Know?