(250) 628-3667
Resident Complaint Form

COMPLAINANT

AGAINST

DATE(s)
Include the end date if incident occurred between a range of dates

If the incident occurred over multiple days, enter the last date here.

DETAILS OF COMPLAINT

Only fill in above if the complaint involves a dog.

The District can keep the complainant's name in confience until required in Court, if necessary.
Other complainant details will be released that may identify you.

I want this complaint kept in confidence*.

The personal information submitted in this form is collected in accordance with Section 26 (c, d, e) of the British Columbia Freedom of Information and Protection of Privacy Act (FOIPPA) (the “Act”) and will be used for the purpose of the Resident Complaint Form. Please be advised that the District of Port Edward is a “public body” as defined in the Act. Questions about the collection, use and disclosure of this information can be directed to the District of Port Edward’s Corporate Office at 250-628-3667 or .