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Service Request Entry - Liquor License Violation Complaints

Please complete as much information as possible and click the Review button.

( ** Mandatory fields have red labels. )


Location:  

Supporting Information

NOTE: CAPTURE ESTABLISHMENT NAME AND ADDRESS
What was the activity / problem that you have observed ?
(Multiple answers allowed)
What was the date of occurrence ?
What was the time of occurrence ?
Has this activity / problem occurred before ?
What days of the week does this activity primarily occur?
(Multiple answers allowed)
What time of day does this activity typically occur?
Input cell # to opt-in for text updates. If opted-in, add cell # to caller info.


Caller / Contact Information
First Name Last Name
Street Address
Address 2
City
E-Mail Address
Contact Type Contact Number   Extension/Comments