| Citizen's Name ______________________________ | Address ______________________________ |
| Citizen's Name ______________________________ | Address ______________________________ |
*Copies of this response shall be provided all parties. When the decision is not in favor of the citizen(s), a copy of the appeal form for the next level will accompany this response.
| FINDINGS: | |
| DECISION: |
| _______________________ Date |
__________________________________________ Signature |