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Third_Party_Complaint

VIEWS: 47 PAGES: 1

									                                                 THIRD PARTY COMPLAINT FORM

                                                                         Case#_____________
                                                                         Officer#___________

                              Per Clay County Ordinance 94-22, section 4-29 enforcement:
                              “A written complaint from any third party alleging a violation” shall
                              be obtained prior to action being taken by the Department Head.
 CLAY COUNTY
   FLORIDA                    Please insert the following information:

                              Complainant’s full name: __________________________________
Public Safety                 Address: ________________________________________________
                              City/Zip Code: ___________________________________________
Clay County Animal Care
and Control                   Home Phone: ________________ Work Phone: ________________
3984 S.R. 16 West
Green Cove Springs, FL        Offender’s Name (If Known):________________________________
32043                         Address: ________________________________________________
                              Nature of
Area code:        904
Phone:            269-6342    Offense:___________________________________________________
Fax:              284-7812    __________________________________________________________
                              __________________________________________________________
                              __________________________________________________________
                              __________________________________________________________
                              __________________________________________________________
                              __________________________________________________________
County Manager                __________________________________________________________
Fritz A. Behring              __________________________________________________________
                              __________________________________________________________
Commissioners:
Wendell D. Davis              __________________________________________________________
District 1                    __________________________________________________________
Douglas P. Conkey             __________________________________________________________
District 2
W. Travis Cummings            Description of Offending
Chairman, District 3
T. Chereese Stewart
                              Animal(s):__________________________________________________
District 4                    __________________________________________________________
Ronnie E. Robinson            __________________________________________________________
District 5

Switchboard:
GCS          (904) 284-6300
                              Date of Offense: __________________
KH           (352) 473-3711
KL           (904) 533-2111   Signature of Complainant: _______________________
OP/MBG       (904) 269-6300
                              Date: _________
www.claycountygov.com

								
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