2. First Name*
3. Last Name*
5. Address1*
7. City*
8. State*
9. Zip*
11. Email
12. Phone
14. Update

    1. I would like to receive updates about this complaint

    If you want to be contacted with information on the status of this violation, please fill out your information.
16. Date & Time Complaint Observed*
    Date & Time Complaint Observed

    Date & Time Complaint Observed
    Date & Time Complaint was Observed
17. Complaint Street Address or Cross Streets*
19. Type of Violation*

    1. Abandoned or Unlicensed Vehicle
    2. Work without Permit
    3. Junk or Trash on Developed Property

    1. Overgrowth of Weeds or Grass
    2. Other (please specify below)
21. Other:
23. For Vehicle violations indicate the Make, Model, Color and Year of Vehicle
25. Picture or File Upload
26. Picture or File Upload
27. Picture or File Upload
29. Please note that all information provided is public information subject to Florida Law
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31. 1. Receive an email copy of this form.
32. Email address

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33. Submit

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