RESTRICTION COMPLAINT FORM

Submit to:
Board of Directors
Willow Farm Pool & Homes Association
P. O. Box 28131
Kansas City, Missouri 64188-0131

TODAY'S DATE:_________________

DATE & TIME OF VIOLATION:_________________________________________

LOCATION OF VIOLATION:____________________________________________

NAME & ADDRESS OF VIOLATION:______________________________________ __________________________________________________________________

DESCRIBE VIOLATION:_______________________________________________ __________________________________________________________________ __________________________________________________________________
(If violation involves vehicle give description and license number)

FOLLOW-UP INFORMATION:___________________________________________ __________________________________________________________________ __________________________________________________________________

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Complainant Information:
Name:__________________________________ Phone:(H)________________ Address:________________________________________________________
(Confidentiality will be maintained)
Complaint received by:______________________________________________

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