District 5 Help Form

District 5 Help Form

Thank you for contacting the Office of Atlanta City Councilmember Liliana Bakhtiari! Please complete this form to help us better your issue and inform our response. If this is an emergency and you need a response within minutes, please do not complete this form and instead call 911.
Date

MonthDayYear
Date
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number. If you do not have a phone number, enter 000-000-0000 as your phone.Format: (000) 000-0000.
Please select your neighborhood.
Please enter your home address.

Street Address

Street Address Line 2

CityState

Zip Code
What is the nature of your concern?
Have you submitted this issue to ATL 311?
Please enter your ATL 311 case number.
Please enter your permit/license/zoning application number.
Please enter your account number.
Have you talked to your neighbor(s) about this concern?
Is the location of the concern the same as your home address?
Location of Concern

Street Address

Street Address Line 2

CityState

Zip Code
Describe the nature of your concern in detail.
Please share the name(s) and Department(s) of anyone you've spoken to at the City of Atlanta about this concern.
Example: I talked to John White in the Department of Watershed Management on April 9th, 2026. Mr. White told me that I should speak with Jane Green. I emailed Jane Green, and she did not respond to me.
What remains unresolved to your satisfaction?
Example: I would like your help in getting in touch with Jane Green so that I can get my watershed issue addressed.
Should be Empty: