Americans with Disabilities Act Complaint Form

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Americans with Disabilties Act Compliance Office

*First Name

*Last Name

*Phone

*Address

*City

*State/Province

*Postal Code

*Please describe the way in which you believe you have been denied any service, program or activity of the Township of Lawrence or have otherwise been discrimated against because of or related to a disability. Please provide names, addresses and telephone numbers of any witnesses.

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