District E

Constituent Request Form

I hope you find this online request form helpful to access me and my staff and key departments within the city. Please take a moment to complete this form if there are any issues that you need to bring to my attention. My door is always open, and I look forward to serving you.

First Name:
Last Name:
E-Mail:
Address:
ZIP:
Subdivision:
Day Phone:
Night Phone:
No trash pick-up
Weeded lot
Water or sewer leak
Illegal Dumping
Drainage problems
Abandoned Building or vehicle
Traffic signal or sign
Other

Comments: