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2. Instructions
   Please include your name and contact information so Village staff can notify you on the progress or follow up for additional information.
4. First Name*
5. Last Name*
7. Address1
9. Address2
11. City
12. State
13. Zip
15. Email*
17. Phone
    Please only insert your phone number if you'd rather be contacted this way instead of email.
19. Face Mask Complaint*
    Please include your complaint, which includes details on the person(s) or business not adhering to the face mask requirement and the date, time, and location you observed the violation.
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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