SCOA Complaint Form

SCOA COMPLAINT FORM

Subject:

(to be filled in by office)

File Number:

(to be filed in by office)

Complaint: Please describe the complaint attaching any documentation, photos, etc. if applicable.
(Use back of form if additional space is required)

Member Making complaint name:

Lot #:

(Complainant's name will not be present on copies)

Phone #:

Date:

Signature:

Complaint Received in Office Signature:

Date:

Receipt of Report: Complainant Signature:

Date:

Complaint Review Committee Date Received:

By Whom:

Status:

Name:

Signature:

Date: