Public Nuisance Complaints

Complaints Concerning Restaurants, Public Lodging or Apartment Buildings of four or more units Call Department of Business & Professional Regulation (850) 487-1395
Complaints Concerning Food Markets, Supermarkets or Convenience Stores Call Department of Agriculture & Consumer services (800) 435-7352
Please Provide As Much of the Information Listed on this Form * Required Information *
* Incident Date:		Today's Date:
Complaint Information		* Your Information *
Business Name:		* First Name:
Owner/Contact Name:		* Last Name:
* Nuisance Address:		* Address:
* Nuisance City:		* City:
State:		State:
Zip Code:		Zip Code:
Phone #:		* Phone #:
Occupant:		Your e-Mail Address
Occupant Address:
Occupant City:		Cell Phone:	Optional
Occupant State:
Zip Code:
Occupant Phone:
* Location of Nuisance * Example: Back of House Next to Alley Please Be Specific
* General Type of Complaint:
* Describe the Nuisance Complaint * Example: Backyard piled up with garbage Please Be Specific
The Health Department Can Not Investigate Your Complaint Without Complete Information And a Method to Contact You Please Provide the Required Information Requested on this Form. Thank You
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