Your name:_________________________________________________________________
Address:___________________________________________________________________
City:_____________________________  Phone:___________________________________
Landlord/Owner:_____________________________________________________________
Manger:__________________________  Phone:___________________________________
Nature of Complaint:__________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Signed:________________________________________  Date:_______________________ Please Return to:  Boone County Tenants Association AO48 Brady Commons Columbia, Missouri 65211

---