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Compliance Violation Submission Form

  1. Name(s) of subject(s) of complaint. If you do not know full name, provide what you can. If you do not know partial name, input "Not Known"

  2. Location of subject(s) of complaint. If you do not know an exact unit, provide what you can. If you do not know location, input "Not Known"

  3. Type of Violation (Owner)*

    Select all that apply

  4. Type of Violation (Tenant)*

    Select all that apply

  5. Type of Violation (Landlord)*

    Select all that apply

  6. Would you be willing to provide your name and contact information in case APCHA staff needs additional information?*

    If you choose to provide contact information, full contact information is not required.

  7. Do you wish to be contacted with the outcome?

    You must provide contact information if you wish to be contacted with the outcome.

  8. Leave This Blank:

  9. This field is not part of the form submission.