Codes enforcement complaint


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BOROUGH OF SUSQUEHANNA DEPOT 



83 Erie Boulevard, Suite A 

SUSQUEHANNA, PA  18847 

(570) 853-4219 

FAX:  (570) 853-5080 

 

CODES ENFORCEMENT COMPLAINT 

 

PERSON MAKING COMPLAINT:                                          NAME/ADDRESS OF VIOLATION: 

 

            ____________________________________                    ____________________________________ 

 

        


 ______________________________                 

____________________________________ 

        


ADDRESS

                                                                               

        _______________________________                

____________________________________

                           

        

PHONE  # 



 

 

       



 I am requesting to the Susquehanna Depot Borough to file the necessary charges on the information I    

am providing.  It has been explained to me that if a hearing in regards to my complaint is requested that I 

will have to appear in person and give testimony to the facts in my complaint.  My failure to appear in court 

to give testimony will result in the charges being dismissed. 

 

On (date):___________________________________     At (time):___________________________________ 

 

Complaint:_________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________ 

 

The information that I have given is true and accurate to the best of my knowledge and belief. 

 

I understand that to give false information or complaint is a crime under Sec. 4904 of the Crimes Code and I 

could be arrested for such act. 

 

 

_________________________________________________          ___________________________________ 

Signature                                                                                                     Date 


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