DATE:
mm/dd/yyyy
Your confidential contact Information:
NAME:PHONE: (XXX-XXX-XXXX) EMAIL: (e.g. name@isp.com)
ADDRESS: (1234 Main St. ) COMMUNITY: (e.g. Alpine, Ramona, Pine Valley, Julian,etc.) STATE:(e.g. CA) ZIPCODE:(e.g. 92123)
Please identify the property of concern:
ADDRESS: (1512 Main St. ) COMMUNITY: (e.g. Alpine, Ramona, Pine Valley, Julian,etc.) STATE: (e.g. CA) ZIPCODE: (e.g. 92123)
ASSESSOR PARCEL NUMBER (in known): (e.g. 282-262-17-00 , look up Click Here) NEAREST CROSS STREET: (e.g. another street nearby)
Additional information if known:
PROPERTY OWNER NAME: PROPERTY OWNER PHONE #: TENANT NAME: TENANT PHONE #:
PROPERTY MANAGER NAME: PROPERTY MANAGER PHONE #:
DESCRIBE THE NATURE OF YOUR CONCERNS: