City of Carrollton                                                                                                                           I / C 02-01

Person Receiving Inquiry ___________________________ Dept. ___________ Date _______ Time _____ AM/PM

Inquirer’s name ________________________________________________________________________________

Address ______________________________________________________________________________________

Location of Problem ____________________________________________________________________________

Nature of Inquiry / Complaint _____________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Attach additional sheets if necessary.

Assigned to for Disposition ______________________________________________________________________

Signed _______________________________________       Title ________________________________________                                                                                                                        

_____________________________________________________________________________________________

Disposition ___________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Attach additional sheets if necessary.

Date _________________________________________   Signed ________________________________________

Complaining party advised of the action taken by the City.

Date _________________________ Initials __________    Title _________________________________________

TO:  SUSPENSE FILE, IF WARRANTED                    SIGNED ______________________________________

FOR DATE: _________________________________       TITLE ______________________________________

                                                                                                 DATE ______________________________________

TO:  ________________________________________     SIGNED ______________________________________

                                Department Head

                                                                                                TITLE ______________________________________

                                                                                                 DATE ______________________________________

                                                                                             SIGNED ______________________________________

 TO:  Mayor  

         For Information and Review                                      TITLE ______________________________________

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