PO Box 157
Turner, Maine 04282
Complaint Form
Complainant: _____________________________________________________________
Name: __________________________________________________________________
Address: ________________________________________________________________
Telephone number _________________________________________________________
Nature of Complaint: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Person believed to be responsible : _________________________________________________
Address: _____________________________________________________________________
Signed : ______________________________ Date: ___________________________________
Received by : __________________________ Date: __________________________________
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Action Taken : ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________