Citizen Request Form
Request for Service or Report an Issue
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number so we can follow up on your request.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
Please enter your email address so we can follow up on your request. example@example.com
Request For Service or Report An Issue
*
(Please be as specific as possible, including all relevant times, dates, locations, details, and the inclusion of any photos or documents.
Responsible Department
*
Please Select
Office of the City Manager
Community Development
Finance
Fire
Human Resources
Parks & Recreation
Police
Public Works
Purchasing
Technology
Not Sure
Have you previously contacted the appropriate department or City Manager on this request
*
Department
City Manager
No
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