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Survey/Form Review
Complaint for Disabled Access Investigation
The purpose of this procedure is to provide individuals with a convenient method to report disability access law violations in Mill Valley, and to establish a process for resolving as promptly as possible alleged violations of state disabled access regulations in either buildings owned or leased by the City of Mill Valley or that are constructed or altered with city funds, or privately owned public accommodations that are not publicly funded.
1. Complainant Nam(e):

2. Complainant Address:
3. Phone number:

4. Email address:

5. Complaint Location:

6. Owner(s):

7. Address:
8. Phone:

9. Description of Complaint:

10. Please choose one or more of the following:













11. Other comments:

Thank you for taking the time to fill out this form. Once you click on "Submit" this information will go to the ADA Coordinator for the City of Mill Valley.