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2. Laconia Fire Department Housing Complaint Form
4. Date*
   Date
6. First Name of Complainant:*
7. Last Name of Complainaint:*
9. Address and Apartment Number*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Email Address*
18. Property Owner's Name*
19. Property Owner's Phone Number*
21. Property Owner's Address*
23. City*
24. State*
25. Zip Code*
27. Nature of Complaint:*
29. Is Property Managed by Laconia Housing Authority*

    1. Yes
    2. No
30. Has Property Owner Been Notified of Complaint?*

    1. Yes
    2. No
32. If the property owner has been notified, what is the owner's action of remedy?*
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

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