Citizen Request Form
Licensed Alcohol
Establishment
For Office Use Only
Control Number: __________
Assigned To: _____________
Date: ____________________
COMPLAINT LOCATION
Business Name:
Business Address:
Time of Activity:
6am to 2pm
2pm to 10pm
10pm to 6am
NARRATIVE
Please provide a detailed description of the complaint:
REPORTING CITIZEN
Full Name:
Telephone:
Address:
Email Address:
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