subject_line
Property Maintenance Complaint Form
Carroll County Department of Inspections
605-1 Pine Street Hillsville, Virginia 24343
Office: 276-730-3016 Fax: 276-730-3178
Complaint Information
Complainant Name:
*
Address of Complaint:
*
Contact Phone Number:
*
Email Address:
Complaint:
*
🛈
Complaint Cont. 2:
Complaint Cont. 3:
Complaint Cont. 4:
Complaint Cont. 5:
Have you contacted the Owner/Landlord in writing regarding your complaint?
*
Yes
No
Do you have a copy of your Lease/Rental Agreement?
*
Yes
No
What has been done to remedy the problem?
*
🛈
Remedy Cont. 2:
Remedy Cont. 3:
Applicant Signature:
*
Date:
*
+