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2. How Do We Contact You?
4. First name:*
5. Middle name:
6. Last name:*
8. Home phone:*
9. Work phone:
10. Cell phone:
11. Phone me between 8 a.m. and 4 p.m. at:

    1. Home
    2. Work
    3. Cell
13. Email*
15. Address:*
    Street Address
17. Apt, Suite, Bldg. (optional)
19. City
20. State / Province / Region
22. Postal / Zip Code
23. Country
25. What Individual or Business is Your Complaint Against?
27. Name of landlord or property manager:*
29. Name of rental management company, if any:
30. Name of property owner, if known:
32. Business / landlord address:
    Street Address
34. Apt, Suite, Bldg. (optional)
36. City
37. State / Province / Region
39. Postal / Zip Code
40. Country
42. Phone:
43. Name and title of person you talked to:
45. Information About Your Complaint
47. Which of the following best describes your first contact with the business? (select one)
    -- Select One --Business sent me information by mailI went to the business/rental unitI telephoned the businessI responded to a posted advertisementI responded to a printed advertisementI responded to a radio or TV adInternetEmail
49. Did you sign a written rental agreement or lease? (select one)

    1. No
    2. Yes
51. Were you provided a copy of agreement or lease? (select one)

    1. No
    2. Yes
53. How old is the person who entered into the agreement? (select one)

    1. 0 to 17
    2. 18 to 61
    3. 62 or older
55. Date lease began:
    Date lease began:
56. Date lease ended:
    Date lease ended:
57. Date you moved in:
    Date you moved in:
58. Date you moved out
    Date you moved out
60. Did you receive a check-in list?

    1. No
    2. Yes
62. Did you receive a check-out list?

    1. No
    2. Yes
64. Before you agreed to rent, were you promised repairs?

    1. No
    2. Yes
66. Were the promises to make repairs put in writing?

    1. No
    2. Yes
68. Were the repairs completed?

    1. No
    2. Yes
70. Were the repairs completed by specified date?

    1. No
    2. Yes
72. Has a building inspector ordered the landlord to make repairs?

    1. No
    2. Yes
73. Date of inspection:
    Date of inspection:
75. What repairs?
77. Name of building inspector:
79. Did you notify the landlord you planned to move?

    1. No
    2. Yes
80. Date notified:
    Date notified:
82. How did you notify the landlord you planned to move?
    -- Select One --Written noticeBy phoneIn person
84. Security deposit amount:
85. Date paid:
    Date paid:
86. Amount returned:
87. Amount withheld:
89. Did you get a written statement accounting for the amounts withheld from your security deposit?

    1. No
    2. Yes
91. Date you received written statement:
    Date you received written statement:
92. If mailed, date statement was postmarked
    If mailed, date statement was postmarked
94. Did the landlord or an employee enter without giving a 12-hour notice?

    1. No
    2. Yes
96. Have you received a written eviction notice?

    1. No
    2. Yes
98. Reason for eviction
99. Date of eviction:
    Date of eviction:
101. Describe your complaint in detail. *
103. How do you feel your complaint should be resolved?
105. This complaint and the information you provide will be used in efforts to resolve your problem and will typically be shared with the party complained against. It may also be used to enforce applicable state laws. Under Wisconsin’s Open Records Law, this complaint will be available for public review upon request, after this department’s action is completed. *

     1. The above information is true and accurate to the best of my knowledge.
107. The City of Green Bay takes all complaints seriously and will process your complaint in a timely fashion. Failure to disclose all required information will result in rejection of your complaint. If you have not received contact from the City of Green Bay within one month from the time of complaint, please follow up with the Wisconsin Bureau of Consumer Protection at:
     Bureau of Consumer Protection
     2811 Agriculture Drive
     PO Box 8911
     Madison, WI 53708-8911
     
     Email DATCP
     Toll-free in WI: 800-422-7128
     608-224-4976
     Fax: 608-224-4939
     TDD: 608-224-5058
     
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109. 1. Receive an email copy of this form.
110. Email address

     This field is not part of the form submission.

111. Submit

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