Complaints and Accolades Form

City Manager's Office
110 East Cook Street, Room 1
Santa Maria, CA 93454
(805) 925-0951
Fax: (805) 349-0657

 

City of Santa Maria Form for Complaints and Accolades

Although anonymous requests are not accepted, all information regarding who submitted the
complaint  or accolade is kept confidential. Please print clearly and fill out this form completely. 
We cannot investigate unless you provide all the information requested below.

1

Date:

 *

Date:

2

Time:

 *

Time:

3

Your Name:

 *

Your Name:

4

Home Phone:

 *

Home Phone:ext.

5

Work Phone:

Work Phone:ext.

6

Mobile Phone:

Mobile Phone:ext.

7

Your Address:

 *

Your Address:

8

Complaint or Accolade Topic:

 *

Complaint or Accolade Topic:

9

Has this Complaint or Accolade been submitted before?

Has this Complaint or Accolade been submitted before?

No

Yes

10

Have you spoken to any City staff about this?

 *

Have you spoken to any City staff about this?

For complaints, Suspect or Property Owner's Information:

11

Name:

Name:

12

Phone:

Phone:ext.

13

Address:

Address:

14

Address of Occurrence:

Address of Occurrence:

To prevent spam we utilize a verification code system. Please enter the code as it is shown in the box below:

 

Code:

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