City of Mingus, Texas

Appendix A — Noise or Disturbance Complaint Form

Referenced in Title IX – Public Peace, Morals, and Safety

Complainant Information

Name
Address
Phone
Email

Location of Disturbance

Address or Description of Location
Property Owner / Occupant (if known)

Type of Disturbance (check all that apply)

Loud Music / Amplified Sound
Vehicles / Engine Noise
Yelling / Fighting / Disorderly Conduct
Fireworks or Explosives
Barking or Noisy Animal
Other (Explain Below)

Description of Incident

Witness Information (if any)

Name		Phone

Complainant Signature

Signature		Date

For City / Police Use Only

Received By		Date Received
Investigation / Action Taken
Follow-Up / Disposition

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