Township of the North Shore
P.O. Box 108, 1385 Hwy 17 Algoma Mills, ON P0R 1A0
Tel. (705) 849-2213 or (705) 461-1821
Fax. (705) 849-2428

Contact

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Community Safety & Wellness

Schedule "A" - Complaint Form

PART A. Person Filing Complaint

Name: *

Address *

City *

Province *

Postal code *

Date of Birth *

Phone Number *

E-mail Address *

PART B. Complainant Information

Name: *

Address *

City *

Province *

Postal code *

Date of Birth

Phone Number *

E-mail Address *

PART C. Details of Complaint

Incident Date:

Incident Time (Approx.):

Incident Description:

Witness Names:

List of Enclosed Documents:

Files

Signature: