Required fields are marked with asterisks (*)

Instructions

If you wish to lodge a concern, you may write your own letter or use this form. Please complete as many areas as you can and provide as much detail as possible. You must provide full contact infomation including your full name, address, and telephone number where you can be reached during regular office hours. concerns must be made in this form or in person at the Township office to complete this concerns form. All concerns will be recieved courteously, investigated, and acted upon fairly. You should be aware that while the Township of Mapleton Makes every effort to assure privacy of the concern, you may be required to present evidence in support of this concern at any hearings of Appeals Committee or Court of Law of Ontario.

First Name and Last Name

Address (civic address and mailing address)

Contact Telephone Number(s)

Email Address

Please provide the name and address of whom the concern is lodged against:

Please provide the date of offence and the time of offence (if applicable):

Nature of Concern (please describe in detail):

Statement of Concern: I hereby make this statement of concern believing it to be true and for no improper or vexatious purpose. I hereby further declare that if required, I will provide or present evidence in support of this concern at any hearing of Appeals Committee or Court of Law of Ontario.

By signing below, I hereby declare that all information I provided is true and I agree to the terms above.

Clear

Date of Signature

In accordance with the Municipal Freedom if Information and Protection of Privacy Act, personal information is collected under the Authority of the Municipal Act (or other applicable legislation) and will only be used for the purposes for which the information was provided.