Delaware County, Indiana

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Health Department Complaint of Conditions that May Generate, Promote, or Transmit Disease Form

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Please fill out this form as completely as possible, providing any and all details you feel may be relevant to an investigation.  *Please note:  A person who provides false information upon which a Health Officer relies in issuing an order under IC 16-20 commits a Class C Misdemeanor. 

* Denotes a required field

Contact Information

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Phone Number*
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About the Potential Violation

 
Violator Phone Number 
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