Code Violation – Commack Fire Department

Your Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Your Phone

Your Email will NOT be used or given out to ANYONE for any reason. It'll be used only in the event more information is needed by the Fire Marshal or to notify you of what if any action was taken

Check to Remain anonymous - It is preferable you do not remain anonymous to the Fire Marshal in case more information is needed from you*

Anonymous to Violator
Anonymous to Fire Marshal and Violator
Not Anonymous

Do you want to be notified if any action was taken. Note: you cannot remain anonymous to the Fire Marshal if you do, however you can still remain anonymous to the Violator*

Yes Contact me via Email
Yes Contact me via Phone
Yes Contact me via Email or Phone
No do NOT contact me

Address of Possible Violation*

Street Address Address Line 2 City State ZIP Code

Is This a Commercial Address i.e. Store/Business or a Residential Address*

Residential
Business

If Commercial - Name of Store/Business

In Detail Describe Your Concern

Report A Possible Code Violation.