OR Great Minster House, 76 Marsham Street, London SW1P 4DR

Matter of complaint:

That the complainant is aggrieved by the defacement by litter and refuse of  < describe the exact section of the road you are complaining about>

That the defendant has a duty to keep the said highway as far as practicable clear of litter and refuse under section 89(1) of the Environmental Protection Act 1990

And the complainant now therefore makes application to the Court to make a Litter Abatement Order pursuant to section 91(6) of the Environmental Protection Act 1990, requiring the defendant to clear the litter and refuse away from the said highway.

The complainant:

Address:

Telephone number:

Who states that the defendant was responsible for the matter of complaint of which particulars are given above

Taken before me

Justice of the Peace / Justice’s Clerk