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Citizen's Two Party Noise Disturbance Complaint Form

Instructions for Completing Citizen's Two Party Noise Disturbance Complaint Form

(Auth: CH. 31B, Sec. 31B-12(f)(2), MCC)

General
 
The information provided on the form will be used to satisfy various legal requirements. It is therefore necessary that the information be accurate and complete. Only the facts concerning one event of an alleged violation of the Montgomery County Noise Ordinance are to be provided on a single form. If you wish to report on more than one event, you must describe each of the other events on a separate form.
 
 
From the facts you describe, it must be possible to satisfy the provisions of the Montgomery County Noise Control Ordinance regarding Noise Disturbances. If the act which you cite is not a violation of the Noise Control Ordinance, you will be informed in writing that we have no enforcement jurisdiction
 
 
For guidance or questions, please call 240-777-7770 and ask to speak with an Environmental Protection Specialist. Copies of the Noise Ordinance are also available.
 
Form Entry Format
 
 
Date: Enter the full date on which you are submitting the form. (dd/mm/yy)
 
 
Name: The names must be the legal names of the involved individuals. Names such as "Mr. and Mrs. Jones" are not legal names. " Deborah G. Jones", first, middle initial and last name, is a legal name. Your legal name is the one on your driver's license or bank account. Only one person's name should be on each line.
 
 
Address, City/Town, Zip Code: Use your residential mailing address.
 
Telephone Number: Please provide a telephone number where you may be reached during the day. We will use this number to advise you of progress on progress on processing your complaint
 
Disturbance Date: Give the date on which the alleged violation of the Montgomery County Noise Control Ordinance occurred. If there are other violations dates, please use separate forms to describe the additional violations.
 
 
Disturbance Time: Give the time the disturbance started and ended. Indicate a.m. or p.m. If the time is not known precisely, make a best estimate.
 
 
Disturbance Location- Address: This is the site the site on which the noise disturbance originated.
 
 
Description of the Act: Describe the nature and extent of the disturbance as best you can placing emphasis on describing the source of the noise and describing how it unreasonably interfered with the use and enjoyment of your own property. This noise event may contain a number of noise producing acts as long as they occurred within the beginning and ending date and times cited above.
 
 
Name of the Person Violating the Ordinance: The name of the person or company violating the ordinance must be legal name, to the best of your knowledge.
 
 
Address, City/Town, Zip Code of the Person Violating the Ordinance: Please enter the mailing address of the accused
 
 
Two Signatures at the bottom of the form: The two signatures at the bottom of the form must be the legal signatures of those individuals. The signatures must be from two (2) adults over the age of 18 years of age. Each person must read all statements, particularly those dealing with conditions necessary to establish a noise disturbance, and fully understand that their testimony will be required, should this matter be heard in the District Court. Please note that your name will be provide to the alleged violator at the time of issuance of the civil citation
 
Learn more about noise issues

Instructions for Completing

Citizen's Two Party Noise Disturbance Complaint Form

(Auth: CH. 31B, Sec. 31B-12(f)(2), MCC)

 
* Required fields
TO: Division Of Environmental Policy and Compliance, Department Of Environmental Protection
 
FROM:

Name 1st Party: *    
Address: *  
City/Town: *
Zip Code :  *
(xxxxx)   
Email :    
Telephone Number: *

(i.e. xxx-xxx-xxxx)    
Name 2nd Party: *  
Address: *  
City/Town: *
 
Zip Code :  *
(xxxxx)    
Email :    
Telephone Number: *

(i.e. xxx-xxx-xxxx):    
Subject: Report of Noise Disturbance
  On: * (Date i.e. 12/12/2000) 
  between the hours of:  
*
          
and
*
 
(Time of day i.e. 12:00 p.m.)
(Time of day i.e. 12:00 p.m.)

 this person:(Name)  created a noise disturbance at the following location:
 Address  :   City/Town: 
 ZipCode  :   (i.e. xxxxx): 
 
                                                   
by performing the following act:
 
  We state, and are willing to state in a court of law, that the sound produced from the performance of the act cited above was: (1) unpleasant, annoying, offensive, loud, or obnoxious: (2) unusual for the time of day or location where it was produced; or (3) detrimental to the health, comfort, or safety of any individual or reasonable enjoyment of property or lawful conduct of business.
In accordance with Section 31B 12(f)(2) of the Montgomery County Code 1984, as amended,  we request that you take enforcement action for the above detailed noise disturbance.
* (1st party signature)
By checking this check box, I sign this application.
 
* (2nd party signature)
By checking this check box, I sign this application.
 
 
 
  
Last edited: 05/06/2013