City of Los Angeles - Complaint Intake Form for Alleged Businesses in Violation of the Safer at Home Order

YOUR CONTACT INFORMATION

What is your name? *

What is your phone number? *

What is your address? *

What is your email address? *

ALLEGED VIOLATOR'S CONTACT INFORMATION

What is the name of the alleged violator? *

What is the address of the alleged violator? *

What is the phone number of the alleged violator? *

If known, what is the email address of the alleged violator? *

NATURE OF THE ALLEGED VIOLATION

Please briefly describe the nature of the alleged violation, including the approximate time of day the alleged violation occurred. *

CONFIRMATION

Please check the below box to certify that the information submitted is true and accurate to the best of your knowledge. *

I certify that the information I submitted is true and accurate to the best of my knowledge.

Required

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