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   Franklin County Department of Public Safety
   50 Claiborne Ave. Rocky Mount, VA 24151
   Fire Inspection Complaint Form
5. Business Name*
6. Street Address (if known)
8. Nature of Complaint (Be as specific as possible)*
10. Please select "Yes" if you wish to remain anonymous. If not, please enter contact information.*

    1. Yes
    2. No
12. Name
13. Street Address
15. City
16. State
17. Zip Code
19. Email Address
20. Phone Number
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