CITIZEN REPORT FORM
CITY OF WINNER, SOUTH DAKOTA 57580 (605) 842-2606 – FAX
(605) 842-1653
Date
_____________
Report taken
by_____________________________
Location of Report _________________________________________________
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Reported By ____________________ _____________________
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Name
Address
Phone#
Report ___________________________________________________________
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Owner___________________ ___________________________ ____________
Name
Address
Phone#
Tenant_____________________ __________________________ ___________
Name
Address
Phone#
Legal Description ID#_________________________________________________
Subdivision _________________________________ Lot ___________ Block ____
__________________________________________________________________
Findings/Contacts made_______________________________________________
___________________________________________________________________
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Received by Supervisor
_____________________________________ Date _______
