715 Yelm Ave E #8 Marshall-CA10 1999
YELM mc.o,
CITY OF YELM
PO Box 479
Yelm WA 98597
(360) 458 -3244
OFFICIAL USE ONLY
Uate Received
By
COMPLAINT RECEIVED FORM
COMPLAINANT (name): 121
F —
PHONE: Ef S � 7-7l
Home Business
ADDRESS:
MAILING ADDRESS (if different than above):
�S
DATE: ( ,/j- -rs Ii 49 `r TIME:
COMPLAINT: (use back or additional paper if needed)
,o �., _ ,� ! o 5z
N
ry P !D 11�-
For Clty of Yelm Official Use Only:
Response /Information Given:
F- S
Sugg sted Action to be Taken:
Complaint and suggested action to Dept. Head 2' 11Y /
Action assigned to:
Action to be initiated by
Action taken if other than above:
Satisfactorily resolved /Completed on: / /