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2. This form is for residents wishing to file a complaint with the city of St. Joseph Health Department concerning a violation of the current Declaration of Emergency. For any additional questions or concerns, please call the health department at 271-4636.
4. Date and Time*
   Date and Time

   Date and Time
6. Name *
8. Call Back Number*
10. Where the Violation Occurred*
12. Date and Time of Violation*
    Date and Time of Violation

    Date and Time of Violation
14. Please Explain the Violation*
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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field