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   Park County Development Services
   P.O. Box 1598, Fairplay, CO 80440
   Phone: 719.836.4267 Fax: 719.836.4351
7. Citizen Complaint Form - Park County Environmental Health
9. First Name*
10. Last Name*
12. Phone Number*
13. Email Address*
15. Address
17. City
18. State
19. Zip Code
21. Forms with incomplete complainant information will not be accepted
25. Person against whom complaint is being made:
27. First Name*
28. Last Name*
30. Physical Address of Property*
32. Legal Address of Property:
34. Subdivision
35. Filing or Unit
36. Lot
37. Tax Schedule #
39. City
40. State
41. Zip Code
43. Description of alleged violation
45. Be advised that if it is determined that a violation exists, then a copy of your complaint may be furnished to the violating party upon request.
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