This form is to be used by the general public in the identification of any abandoned and/or distressed residential properties which have been observed in the City of Cloverdale.

Please fill out the information requested below so that City staff can investigate in accordance with any applicable City Ordinance(s).

Date Observed*

Address or Location*

Describe any Nuisance Observed*

Thank you for completing this form. The City will investigate the situation and reslove any issues in accordance with applicable City Ordinance(s). If you wish us to contact you after our inspection to discuss our approach on this matter, please provide us with your contact information in the box below.

Reporting Party Name, Address, and Telephone No.