Citizen's Two Party Noise Disturbance Complaint

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

(Authority: Montgomery County Code, Section 31B-12(f)(2)

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 Montgomery County's noise law 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.

If the act which you cite is not a violation of the noise law, you will be informed in writing of this fact and the reason for the determination.

For guidance or questions, please contact the Department of Environmental Protection by:
1. Calling the Montgomery County Customer Service Center at 240-777-0311
2. Contact DEP
3. Refer to the DEP website

View text of the Montgomery County noise control law.

Instructions for Completing this Form

Today's Date: Enter the full date on which you are submitting the form. (dd/mm/yy)

Name: The legal names of the individuals reporting the alleged violation. Your legal name is the one on your driver's license or bank account. Only one person's name should be listed on each line.

Address, City/Town, Zip Code: Use your residential mailing address.

Email: A confirmation notice regarding the receipt of this form will be sent to this email 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 law 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.

Person or Entity Creating the Disturbance: The name of the person or company violating the ordinance must be a legal name, to the best of your knowledge.

Location of Noise Disturbance: This is 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.

Address of the Person or Entity Violating the Noise Control Law 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 the individuals reporting the alleged disturbance. Each individual must be over the age of 18. 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. View text of the Montgomery County noise control law. Please note that a copy of this form, which includes your contact information, will be provided to the alleged violator if there is sufficient evidence to issue a civil citation.

To: Division Of Environmental Policy and Compliance, Department Of Environmental Protection

1st Party first name:*

Please enter the name

2nd Party first name:*

Please enter Name

1st Party last name:*

Please enter the name

2nd Party last name:*

Please enter Name

1st Party Apt/suite:

2st Party Apt/suite:

1st Party street NO:

2nd Party street NO:

1st Party street name:*

Please enter the Street.

2nd Party street name:*

Please enter Street.

1st Party City/Town:*

2nd Party City/Town:*

Please enter City/Town

1st Party Zip Code :*

(xxxxx)Please enter Zip code Check Zip code

2nd Party Zip Code :*

(xxxxx) Please enter Zip code Check Zip code

1st Party Email :

2nd Party Email :

1st Party phone #:*

(i.e. xxx-xxx-xxxx)Please enter Telephone number. Please check telephone number

2nd Party phone #:*

(i.e. xxx-xxx-xxxx)Please enter Telephone number Please check telephone number

Subject: Report of Noise Disturbance

On:

* (Date i.e. 12/12/2000) Please enter Date

between the hours of:

* Please enter hours

and* Please enter hours

(Time of day i.e. 12:00 p.m.)

this person:(Name/Company) (last Name if any)

created a noise disturbance at the following location:

Apt/Suite # Apt/Suite #:

Street No:

Street Name:

City/Town:

ZipCode: (i.e. xxxxx): Check Zip code

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. Please enter name.

* (2nd party signature)

By checking this check box, I sign this application. Please enter name

CAPTCHA Validator

Retype the characters from the picture: