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2. 
3. Township of Bloomfield

   Department of Community Development

   CITIZEN COMPLAINT FORM

5. Name:*
6. Address:*
8. Phone Number:
9. Email Address:
11. Complaint:*
13. Suggestions on how we can better serve the community:

15. Thank you for your time. Someone from the Township will be in contact with you on the next business day n reference to this concern.

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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

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