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Tell the City Form

2. First Name*

3. Last Name*

5. Phone*

7. Email*

9. Type of Issue / Report
   -- Select One --A Good ExperienceCrime Info or LeadsGraffitiHousing Code Violation(s)PotholesSnow Plowing ProblemStorm Water or Drainage ProblemStreetlight ProblemTraffic Speed Problem

11. Problem Location*

    Please explain where this problem has occurred.

13. Description / Message*

    Do you have any other comments or further description?

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15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

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