Citizen Complaint Form

Submit your complaint with details and witness information for the Millersville Rural Fire Protection District.

Date of Event:*

Time of Event:*

First Name*

Middle Initial

Last Name*

Phone Number*

Enter your email address*

Are you willing to come before the Board of Directors for the Millersville Rural Fire Protection District with this complaint?*

Yes

No

Witnesses: Name & Phone Number

Describe your complaint details*

I hereby certify that the statements given by me herein are true and accurate to the best of my personal knowledge. I understand that making intentional false declarations to public servants or untrue statements under oath or affirmation may be punishable by law. I further understand that I must personally sign this complaint in order for it to be valid, and that false reporting in an attempt to unjustly subject a member to undeserved discipline or slander, or place his/her membership in jeopardy, can result in criminal charges.*

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contact@MillersvilleFireMO.gov

573-243-1660

155 County Road 482, Millersville MO 63766

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