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:

Email / Correo Electrónico:

Address / Dirección:

ZIP / Código Postal:

Subdivision:

Phone / 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 ilegalmente ... Drainage problems / Problemas con el drenaje ... Abandoned Building or vehicle / Vehiculo o edificio abandonado ... Traffic signal or sign / Señal de trafico ... Other / Otro

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