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? *
Your answer
What is your phone number? *
Your answer
What is your address? *
Your answer
What is your email address? *
Your answer
ALLEGED VIOLATOR'S CONTACT INFORMATION
What is the name of the alleged violator? *
Your answer
What is the address of the alleged violator? *
Your answer
What is the phone number of the alleged violator? *
Your answer
If known, what is the email address of the alleged violator? *
Your answer
NATURE OF THE ALLEGED VIOLATION
Please briefly describe the nature of the alleged violation, including the approximate time of day the alleged violation occurred. *
Your answer
CONFIRMATION
Please check the below box to certify that the information submitted is true and accurate to the best of your knowledge. *
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