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.

Your First Name:

Your Last Name (25 characters max):

Your Email:

Address:

ZIP:

Subdivision:

Phone:

No trash pick-up ... Weeded lot ... Water or sewer leak ... Illegal Dumping ... Drainage problems ... Abandoned Building or vehicle ... Traffic signal or sign ... Other

Your comments ...


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