CODE ENFORCEMENT MEMORANDUM
Information Shall Be Supplied By Citizen Making Complaint

NAME OF COMPLAINANT ______________________________________________

STREET _______________________________________________________________

CITY/STATE/ZIP _______________________________________________________

TELEPHONE HOME: _____________ WORK: ____________________

PROBLEM _____________________________________________________________

_______________________________________________________________________

FOR WHAT REASON IS THIS COMPLAINT BEING MADE?

HEALTH ____________ SAFETY _____________  WELFARE ______________

The following information can be obtained from the Schodack Town Hall
when filing the complaint:

SECTION OF CODE VIOLATION _________________________________________

TAX MAP NUMBER _____________________________________________________

NAME OF OWNER OF PROPERTY _______________________________________

ADDRESS OF OWNER __________________________________________________

NAME & ADDRESS OF TENANT    _________________________________________
ON PROPERTY (if applicable)
			    ____________________________________________

Attention: I understand that this complaint may result in a court action\
being taken against the owner of the property and/or tenant of the property.
At this time I understand and agree that I will appear at all court
appearances which should arise from this complaint.

Date:____________ Signature of Complainant: _____________________________________
 	  				

Witnessed By: ________________________________________________________