District H

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 / Primer Nombre :
Last Name / Apellido:
E-Mail / Correo Electrónico:
Address / Dirección:
ZIP / Código Postal:
Day Phone / Numero de teléfono:
Night Phone / Otro Numero de Teléfono:
No trash pick-up / No recogieron
la basura
Weeded lot / Lote lleno de hierbas
Water or sewer leak / Escape de agua rota o agua sucias
Illegal Dumping / El tirar basura
Drainage problems / Problemas con el drenaje
Abandoned Building or vehicle / Vehiculo o edificio abandonado
Traffic signal or sign / Señal de trafico
Other / Otro