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Face Mask Complaints

2. Instructions
   Please include your name and contact information so Village staff can notify you on the progress or follow up for additional information.

   Please include your name and contact information so Village staff can notify you on the progress or follow up for additional information.

4. First Name*

5. Last Name*

7. Address1

9. Address2

11. City

12. State

13. Zip

15. Email*

17. Phone

    Please only insert your phone number if you'd rather be contacted this way instead of email.

19. Face Mask Complaint*

    Please include your complaint, which includes details on the person(s) or business not adhering to the face mask requirement and the date, time, and location you observed the violation.

Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field