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By-Law Complaint Form

Schedule A – By-law 2016-36

All complaints for Mildmay, Teeswater and Formosa will be received courteously, investigated and acted upon fairly. You should be aware that while the Municipality of South Bruce makes every effort to assure privacy of the complainant, you may be required to present evidence in support of this complaint at any hearings of Appeals Committee or Court of Law of Ontario.

Date

Your Name

Home Phone Number

Cell Phone Number

Work Phone Number

Email Address

Mailing address

What is your preferred method of communication?

Telephone

E-mail

Mail

No Preference

What is your Concern? Please include relevant date(s), time(s), location, address and background information, including municipal employees you have contacted regarding this matter.

How could the situation be improved?

Additional Information

Supporting documentation such as relevant photographs, can be attached to this form

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Statement of Complainant: I hereby make this statement of complaint believing it to be true and for no improper or vexatious purpose. I hereby further declare that if required, I will provide or present evidence in support of this complaint at any hearings of Appeals Committee or Court of Law of Ontario.

Thank-you for taking the time to explain your concern. We will provide a response to your concern as soon as possible. If you have any questions about the process, please contact the Municipal Administrator-Treasurer at 519-392-6623.

The personal information collected on this form is collected under the authority of the Municipal Act and will be used to receive and investigate public complaints. Questions about this collection should be addressed to the Municipal Clerk at 21 Gordon Street, Teeswater, On N0G 2S0 Tel: 519-392-6623 ext. 224

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By-Law Complaint Form

Schedule A – By-law 2016-36