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City of Brockton

Board of Health    Record of Complaint


In order for us to act on your complaint we will need to contact you to set up an appointment.   For that reason all fields marked with an asterisk (*) are required.

 

*Your Name   *Your Phone Number  

*Your Address   *Floor or Apt. Number  

*Your E-mail Address   

*Does a child under the age of Six (6) reside in the apartment?
*Your Complaint
 

 

If your complaint is about a property owner or agent please fill out the following.

About Whom Their Phone Number

Their Address

Their City Their State Their Zip Code

 


    

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