Your Full Name:
Community Organization or Block club Name:
Email Address:
Phone:
Your Address:
Address of nuisance property (If Known) :
City:
State:	Alberta Alaska Alabama Arkansas Arizona British Columbia California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Manitoba Maryland Maine Michigan Minnesota Missouri Mississippi Montana New Brunswick North Carolina North Dakota Nebraska Newfoundland New Hampshire New Jersey New Mexico Nova Scotia Northwest Territories Nevada New York Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island South Carolina South Dakota Saskatchewan Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Yukon Territory
Zip:
Is The Property Occupied?	YesNoUnknown
Is The Property Open to Trespass?	YesNoUnknown
Does the property have any fire damage?	YesNoUnknown
Select files to Attach
Please include any additional details regarding the nuisance property