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2. 
3. Wyoming County Health Department
   Environmental Division
   5362 Mungers Mill Road, Silver Springs, Ny 14550
   Telephone 585-786-8894
   Nuisance Complaint Report Form
5. All Contact information is required and will be kept strictly confidential. Any Reports recieved without accurate contact information will deemed invalid
7. Date Filed*
   Date Filed

   Date Filed
9. Individual Registering Complaint:
11. Name*
12. Email Address
14. Address*
16. City*
17. State*
18. Zip Code
20. Phone Number*
24. Complaint Regarding:
26. Name*
28. Address*
30. City*
31. Zip Code
33. Phone Number
35. Nature of Complaint:*
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

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