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2. Description
   If you would like to report a problem in your apartment or other rental unit, complete this form. The fields with an asterisk (*) are required. If you want to report an issue in your neighborhood, other than the building you live in, please fill out the Report a Possible Code Violation form. The inspector will need to contact you in order to follow up on your request and/or complaint; please complete the entire form. Information related to the complaint is confidential and will not be released to the public.
4. First Name
5. Last Name
7. Phone number*
8. Phone Type
   -- Select One --HomeCellWork
9. E-mail Address
11. Adress*
12. Apt/Unit
14. City*
15. State*
16. Zip Code
18. Description of Violation (be specific)*
    Examples: bathroom sink is clogged, roaches, broken windows, open wires, holes in walls, or bad wiring.
20. Are you a tenant and on the lease of this property?*

    1. Yes
    2. No
22. Have you notified the landlord or property manager of your concerns?*

    1. Yes
    2. No
24. If so, what was the response to your requests?
26. Are there any court or other legal actions pending regarding this issue?*

    1. Yes
    2. No
    3. Unknown
28. In order to investigate your complaint, a city inspector will need to gain access to your unit. Will you be available to allow the city inspector access to your rental unit?*

    1. Yes
    2. No
30. Tennessen Warning
    Data that identifies individuals who report violations of laws concerning the use of real property are classified as confidential data under the Minnesota Government Data Practices Act. The city may collect such data from renters. The information is necessary to contact the renter to schedule an inspection and to be able to obtain any additional information that may be necessary to address specific complaints. Complainants are not required to provide their personal information. In the case of an interior housing tenant complaint, the city is unable to take any enforcement action against the property owner unless a tenant is willing to cooperate with the city so interior violations can be verified. The identities of individuals who register complaints about the use of real property is not be provided to the public, but an individual who is potentially subject to criminal or civil penalties for an alleged violation may have the right to obtain the identities of complainants if his/her due process rights so require.
32. Tennessen Warning Acknowledgement*

    1. I acknowledge that I have read and understand the Tennessen Warning.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field