Purpose:

The purpose of this form is to file a formal complaint against a resident at Marilla Country Village who is causing a disturbance of some kind. Neither the Property Manager nor the Board of Directors of Marilla Country Village can pursue any complaint against any resident unless we receive the complaint in writing (submitted here or in paper form).

Please fill out all information requested below. Unless we get complete, accurate information, we cannot pursue any action against the person causing the problem.

We cannot pursue anonymous complaints. Every effort will be made to keep the identity of you and your witnesses confidential.

* = This information is required. Your information will be kept confidential.

1*. Your Information:

*Name:
*Address:
*Phone:
*E-Mail:

Witness Information:

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2*. Did you witness this disturbance? ---NoYes

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3. Please list any other individuals that witnessed this disturbance:

Violation Report/Disturbance Information:

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3*. Lot number or location where this disturbance/violation occured (please be specific):

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4*. Date and time of violation:

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5*. Name of resident/guest, or descriptions of person(s) causing the disturbance/violation:

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6*. Description of disturbance/violation:

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7*. Was an animal(s) involved?
---NoYes
If yes, did you notify the town animal control officer (ACO: (716) 800-7626) or the Department of Environmental Conservation (DEC: (716) 851-7050)?
---NoYes, I called the ACOYes, I called the DECYes, I called the Police

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8*. Was a vehicle(s) involved?
---NoYes
If yes, please include a vehicle description (make/model/year/type/license/etc.):

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9*. Did you notify the police? (Emergency: 911 - Non-Emergency: (716) 858-2903)
---NoYes, I called the Police
If yes, did you obtain a complaint number or police report?

10. Images and Attachments:

All attachments, supporting documentation, and pictures of the violation must be submitted with this violation or be sent to the Property Managment office directly. If you are mailing your attachments, please include a note specifying those documents go with this complaint.

Attach a file (#1):
Attach a file (#2):
Attach a file (#3):
Acceptable file types: JPG or PDF

11*. Disclaimer:

By checking the following, I have read, understand, accept, and admit that all submissions on this form are truthful upon this form above. I understand that I may be contacted to verify or elaborate upon this submission.

← *Check here to accept this form.

Please enter: