By-Law Complaint Form

Your Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Phone Number *

Email *

Address/Location of Complaint

Location *

Name of Complaint Property Owner (if known)

Is it visible from the road? *

Yes
No

Is it visible from your property? *

Yes
No

Nature of Complaint

Complaint Details *

Attach Pictures or Supporting Documentation

Click or drag files to this area to upload. You can upload up to 10 files.

Declaration *

I, hearby declare that the information given in this form is true, complete and accurate.

Date / Time *

Date

Time

Notice of Collection

The Township of Puslinch collects information under authority of section 227 of the Municipal Act, 2001. Any personal information collected on this form is intended to be used for investigation and related activities and in contacting you regarding your complaint, if necessary. Questions about the collection of this personal information can be directed to the Clerk's Department at 519-763-1226 x5 or by mailing them to: Township Office, 7404 Wellington Rd 34, Puslinch, ON, N0B 2J0

Personal information on this form is collected under the authority of the Municipal Act and is maintained in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information may be directed to the Township Clerk’s office.

The Township of Puslinch is committed to providing accessible formats and communication supports for people with a disability. If another format would work better for you, please contact the Township Clerk’s office for assistance.

Instructions

Your Information

Address/Location of Complaint

Notice of Collection

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