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ADA Complainant Form

  1. Town of Davie

    6591 Orange Drive
    Davie, Florida 33314
    Phone: 954-797-1000
    Fax: 954-797-1087

  2. Town of Davie
    Title VI and ADA Complaint of Discrimination

  3. Type of Discrimination

  4. 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.

  5. Note: Alternate means of filing complaint, such as a personal interviews or a tape recording of the complaint, will be made available for persons with disabilities upon request.

  6. Submit to:

    Evelyn Roig, Town Clerk
    ADA Coordinator
    Town of Davie
    6591 Orange Drive
    Davie, Florida 33314
    Email: [email protected]
    Phone: 954-797-1000
    Fax: 954-797-1087
    TTY: 954-828-5520
    Florida Relay (Voice): 800-955-8770
    Florida Relay (TTY): 800-955-8771

  7. Leave This Blank: