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2. To report a street repair, please select the item that you would like to report from the drop-down list below.
4. First Name*
5. Last Name*
7. Phone Number*
8. Email Address*
10. Choose Repair*
    -- Select One --PotholeSignageSidewalkOther
12. Please fill out the additional description regarding your report.
14. Street Address*
16. If you feel the street address will not provide our staff with an exact location, help us by describing more about this location (i.e. across from the church, in front of a house). Use as much space as required. Thank you.
18. More Information...
20. Upload an Image (Optional)
22. Thank you for your report. Our team will review this as soon as possible.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field