Mid-Michigan District Health Department

Complaint Form

City of Greenville Tobacco Free Outdoor Recreation Areas

     

 

 

 1. Location of the violation (e.g. Park, Playground or Trail): *

 2. Date of the violation: *

 3. Time of the violation (e.g. 1:35pm): *

 4. I wish to make a complaint against:

      Name (if known):

      Address (if known):

      Phone (if known):

 5. Specifics of the complaint are: *

 6. How often do you use the outdoor recreation areas in Greenville: (e.g. once a week)

    Your Name: *

    Your Address: *

    Your Phone: *

    Your Email:

Please note that all complaints are confidential and that personal information is not released except in response to a Court Order

  
 
 

©2011 Mid-Michigan District Health Department