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Derelict Structure Form
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Assumption Parish Police Jury
To the Assumption Parish Police Jury:
The undersigned of the Parish of Assumption does hereby file complaint that the below stated property owner is in violation of the Assumption Parish "Derelict Structure" ordinance (06-19).
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Enter your first name
Enter your last name
Enter your address
Enter your city
Enter your zip code
Enter your email address
Enter your phone number
Property Owners Name
Enter the name of property owner
Address to Property in Violation of "Derelict Structure" Ordinance
Enter address of property in violation
Enter city of property in violation
Enter zip code of property in violation
You are required to enter pictures of the vehicle/property in violation
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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