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Codes Complaints Form
Use this form to submit a codes complaint.
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Alleged Violation Information
Address of Alleged Violation:
*
Street Address
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Occupant Name (if known):
*
Alleged Violation
*
Complainant's Information:
Complainant's Name
*
Complainant's Address:
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Phone
*
Submission Agreement
*
I hereby affirm that the information contained in this Codes Complaint is true and correct to the best of my knowledge and is being provided with the intent that the representations in it may be relied upon by the Borough of Middletown in connection with potential enforcement actions or in the performance of other official governmental functions. This written Codes Complaint is intended to be made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities.
Complainant's Signature
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All complaints must be signed and must contain the name of complainant. Anonymous complaints will not be investigated. Names of complainants will not be made public; however, please be aware should the complaint result in enforcement proceedings in District or Dauphin County court, the Borough cannot protect the complainant's anonymity.
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