F.A.C.T.S. SUBMISSION FORM cpogorzelski Submitted by cpogorzelski on Tue, 03/16/2021 - 10:45 NAME First Name Last Name CONTACT INFORMATION County Email Phone Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code DATE OF INCIDENT If ongoing, leave blank DESCRIPTION OF ISSUE About text formats Plain text No HTML tags allowed. Web page addresses and email addresses turn into links automatically. Lines and paragraphs break automatically. Please tell us in as much detail as you can what the problem is, the parties involved, whether or not the issue is ongoing, and what steps have been taken to resolve the problem.
