Compliment/Complaint/Suggestion Form - Fillable

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This is machine-extracted text, not the document. It was extracted from the town's PDF; layout, tables and figures may not survive intact. The town's copy is authoritative; open it before relying on anything here.

Town Of Durham                               durhammaine.gov
                                          www.durhamme.com
   630 Hallowell Road                            Tel: 207-353-2561
  Durham, Maine 04222                            Fax: 207-353-5367

Incorporated 1789

Compliment/Complaint/Suggestion Form

Check One: Compliment                    Complaint      v             Suggestion

Your Name:___________________________________________________________________________

Address: _____________________________________________________________________________

Telephone number: __________________________ Email: ___________________________________

Compliment/Complaint/Suggestion (Include nature and location):

(continue on back if needed) Signature of Complainant: _____________________________________

Do you want a response? Yes     No
How do you want us to respond? Phone       Email      Mail
Please make sure you have included your contact info.

Below for Office Use Only ______________________________________________________________

Date_________________ Time________________ Received by ___________________________ How Reported: Telephone__ In writing__ In person__ By Fax__ E-mail__ (check all that apply) The original will be filed in the Town Office. Copies emailed to Select Board ___

Complaint or Concern forwarded to:__________________________________________________
                                      (Name)                              (Department)

Forwarded by: mail______, e-mail______, faxed______, in person______ Date _______________________ Time_______________ Initials_______

Action Taken by Department Head: ______________________________________________ ______________________________________________________________________________ Notes: ________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Revised: May 19, 2017 Approved: May 30, 2017 by Select Board

Source: compliment_complaintform2024_fillable-1-.pdf on durhammaine.gov. Text extracted with pdftotext; no wording has been corrected.