RCI Complaint Form

RCI Complaint
Property Information
Street Address*
Section:
Block
Lot
Town*
Village*
Village*
Village*
Village*
Village*
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Property Owner Information (if known, Optional)
First Name:
Last Name / Business Name:
Complaint Information
Housing complaints only
Nature of Complaint:*
Critical*

Utilities: No Heat, Gas & Electric, Water ServiceFire Safety: No Smoke Detector, CO Detector, Electrical, Egress, OtherIllegal Occupancy: Rooming House, Basement, Attic, Garage, OtherOver-occupancyHoardingSewage (inside residence)Other
Non-critical*

General Construction Interior: Walls, Floors, Ceiling, Doors, Windows, OtherGeneral Construction Exterior: Roof, Deck, Stairs, Handrails, OtherPlumbing: Leaks, Pipes, OtherGarbage, Debris (exterior, interior)KitchenBathroomPests: Cockroaches, Bedbugs, Fleas, Flies, Mice, Rats, OtherOdorsLead PaintAnimal Feces: Bird, Cat, Dog, OtherOther
Additional details of your complaint
Complainant Information (Your identity will be kept confidential)
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
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Phone Number*
Fax Number
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RCI Complaint