The Fort Wayne Allen County Department of Health

Smoking Complaint Form

Allen County Smoking Complaint

This complaint form is only applicable to violations of the Allen County Smoking Ordinance. If you have a complaint regarding a smoking violation within the city of Fort Wayne, please call
Fort Wayne Fire Code Enforcement at (260) 427-7665.

Name of Establishment Where Violation Was Observed: Establishment Address: Jurisdiction Where This Violation Occurred: Date Observed: Time Observed: This Complaint Is Against: If A Business, What Violation Did You Observe?
For multiple choices, use the CTRL key If An Individual, Describe the Violation You Observed:
Description of Individual:
Specific Location Observed:
ie. front door, bathroom, back door, etc. Other Descriptive Information: Complaint Description:

Your Contact Information (optional)

Name: Daytime Phone Number: Address: