11 W. Monument Ave., Suite 606, Dayton, OH 45402
(937) 223-4613 • 1-800-395-8267
E-mail Us •
Required information shown with *
What is your complaint about?
What agency (or agencies) are you complaining about?
First Name(s) *
Last Name *
Mailing Address *
Zip Code *
Alt Phone *
If you are complaining on behalf of someone else, who is it?
What is your relationship to this person?
Summarize any other information that you feel might be relevant to your complaint. *
How are you sending the supporting material?
(If sending material by post or fax please label clearly with your personal details)
By mail: Dayton Ombudsman Office, 11 West Monument Ave., Suite 606, Dayton, OH 45402
By fax: 937-228-1183
Answering the following questions is optional but your answers will help us improve our service delivery.
How did you hear about the Ombudsman?
General Knowledge/Previous Contact
Word of Mouth
If "Other", what?
Woman wins financial independence
Woman’s mail mishap resolved
Woman’s waste container mess cleaned up
©2017 CONTACT US:
11 W. Monument Ave, Suite 606,
(937) 223-4613 or
Fax: (937) 228-1183