NORTHERN TOWNSHIP
445 Town Hall Road NW
Bemidji, MN 56601
“Confidential”
COMPLAINT FORM
Address of Complaint : _________________________________________________________________
Name of Property Owner (if known):_______________________________________________________
Description of Complaint : __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
The name of the person initiating this complaint (claimant) is not public information and his/her identity will be kept in strict confidence.
CLAIMANT: ________________________________________________
DATE: ________________
ADDRESS: _________________________________________________
PHONE #: ______________
__________________________________
Signature of Claimant
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FOR OFFICE USE ONLY:
Findings: _____ Land Use Ordinance violation
_____ Public Nuisance Ordinance violation
_____ Found complaint to be invalid
Date of Inspection: __________________________________
Specific Violation:______________________________________________________________________
_________________________________________________________________________
Section of Ordinance Violated: ___________________________________________________________
Letter of recommendation to Town Board of Supervisors states: _________________________________
_______________________________________________________________________
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