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Your name *
Your address *
Telephone number *
Email address *
Preferred method of contact * Phone Email
If by phone, best time to call
Is an interpreter needed, and if so which language?
Date incident(s) occurred
Where is the nuisance coming from? * -Next door neighbourPeople from the same streetPeople from a different estate/area
Is more than one person causing the nuisance? Yes No
Is the perpetrator under 18? Yes No
What is the name of the perpetrator?
What is the address of the perpetrator?
Type of ASB * -Verbal abuse / harassment / intimidationHate-related incidentsVandalism and damage to propertyPet and animal nuisanceVehicle nuisanceDrugs / drug-dealing / substance-abuseAlcohol-relatedDomestic abuse or physical violenceLitter / rubbish / fly-tippingGarden nuisanceMisuse of common areas / loiteringProstitution / sex acts / kerb-crawlingNoiseRacial harassmentOther criminal behaviour
Details of ASB *
Have you taken any action to resolve the issue, i.e. spoken to the perpetrator(s) Yes No
If yes, please describe the action taken
Have the police been informed? * Yes No
If yes, please provide details, including crime reference no.s
Is this an original report, or does it relate to an ongoing case? * Original report Ongoing case
If ongoing case, please type the ASB reference number (if known)
Last modified 23/04/09
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