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Please add additional complainant(s) names separated by a semi-colon.
Please enter the primary complainant's address
Please provide the phone number of the Primary Complainant.
Please provide the email address of the Primary Complainant.
Please include Name, Address, Phone Number, and Relationship (e.g. friend, attorney, parent, etc.).
Please separate names by comma.
Please list the name(s) and phone number(s) of any person, if known, that the City of Pensacola could contact for additional information to support or clarify your allegation(s).
Please explain as clearly as possible how, why, when and where you believe you were discriminated against. Include as much background information as possible about the alleged acts of discrimination.
This field is not part of the form submission.
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