Noise Disturbance Complaint Form

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City Government

Noise Disturbance Complaint Form

First Name *

Last Name *

Date *

Address *

Address

City

Province

Postal Code

Phone Number *

Email Address *

Do you consent to the release of this information? *

Yes

Details of Incident

Date *

Address

City

Province

Postal Code

Start Time

End Time

Duration

Who/What *

(Name (if known), description, vehicle make/model, licence number, other details)

Compared with normal conversation, the noise at the point of reception was:

Much louder

Louder

About the same

Quieter

Much quieter

I, consent and confirm the following: *

This information is accurate to the best of my knowledge and belief

The noise as described was disturbing to me

If it becomes necessary, I am prepared to give evidence in court

Check all that apply

Air conditioner

Amplified Music

Construction

Heat pump

Radio/stereo

Shouting

Vehicle

Ventilation System

Option 9

Option 10

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