City of Pine Lake Police Department

456 Pine Lake Drive / P.O. Box 1325

Pine Lake, Georgia 30072
Phone: (404) 292-4250 / Fax: (404) 292-7531

Email: plcodeenforce@bellsouth.net

Complaint Information
OPTIONAL INFORMATION (You may remain anonymous)

Requestor’s Name:
Address:
Telephone Number:

Required Information:

Alleged Violation’s Name or Business

Violation Date: ______/______/______ Time: _____________ AM PM

Problem(s) / Violation(s):

Sign by

Date ________/________/_________

Official Police Department Business

This form will be forwarded to our License Code Enforcement Officer assigned to that area. He will respond to all Complaint Forms
in order as they are turned in. Complaints will be investigated within (5) business days. Please provide your contact number and or
email address if additional information is needed. To ensure that procedures are followed correctly, allow the PL Police department
to handle your request immediately without taken matters into your own hands. For more information, or to speak with an Officer,
contact Code Enforcement at (404) 292-4250, Fax (404) 292-7531 or email at: plcodeenforce@bellsouth.net