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Manufactured Housing Complaint Form - Maine Department Of Professional And Financial Regulation Page 3

Please list the specific complaint items below:

1.________________________________________________________________________________________

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2.________________________________________________________________________________________

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3.________________________________________________________________________________________

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4.________________________________________________________________________________________

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5.________________________________________________________________________________________

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6.________________________________________________________________________________________

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7.________________________________________________________________________________________

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8.________________________________________________________________________________________

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9.________________________________________________________________________________________

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10._______________________________________________________________________________________

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11._______________________________________________________________________________________

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(ATTACH ADDITIONAL DOCUMENTION AND PHOTOS IF NECESSARY)

Have you previously filed a complaint with this Board? _____ If so, list dates______________________________

________________________________________

________________________

(Complainant’s Signature)

(Date)

Manufactured Housing Complaint Form - Maine Department Of Professional And Financial Regulation Page 3