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SAMPLE FORM <br /> City of <br /> • Complaint Fora <br /> Date : <br /> �o:nplaint : <br /> Address/Area : <br /> Complaint/Adaress : <br /> • Reported Tv : Date : <br /> Action Taken : <br /> Date : <br /> Verification : Date : <br /> Follow-up : Date : <br /> Additional Action : <br /> Recoraed <br /> By : <br /> • All supporting data attacheC <br /> 303 <br />