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Complaint Information Sheet

  1. Please enter today's date.

  2. Time

  3. General Information

  4. Are you an: *

    Please check the appropriate box

  5. Do you wish to remain anonymous?*

    (if yes, do not answer the following 3 questions)

  6. Complaint Information

  7. Is it still ongoing?*

  8. Name the person and/or business. List the address of the complaint.

  9. Have you talked with anybody else about your complaint?

  10. This complaint will be sent to the Atchison County Counselor and the Board of County Commissioners for review to see if an investigation may be warranted or if this information should be referred to another agency.

  11. Leave This Blank:

  12. This field is not part of the form submission.