LACKAWANNA COUNTY DISTRICT ATTORNEY'S OFFICE
COMMUNITY COMPLAINT FORM
*If a response is other please explain in Additional Comments
Date:
Location Code*:
(1) Carbondale
(2) Southside of Scranton
(3) Hill Section of Scranton
(4) West Side
(5) Other Area Below
Personal Information
Last Name:
First Name:
Address (1) :
Address (2):
City / Town / Boro:
Zip Code:
Phone:
Alt. Phone:
Email Address:
Age:
Issues
(Check All That Apply)
QUALITY OF LIFE
Garbage
Appearance
Utility Problems
Children Issues
Structural
Other*
DRUGS
Vandals
Family Violence
Illegal Residents
Fire Arms
Violence
Theft
Other*
ZONING
Improper Use
D.E.P. Issues
Fire Hazards
Junk Cars
Other*
Extended Information
Location of Problem or Occurrence:
Explain the Issue:
Additional Comments: