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Survey/Form Review
Template 04: Citizen Request Form
If you have a specific request for action to be taken by the City, such as reporting a pot hole or code enforcement concern, you may submit it through our Citizen Request Form.

Please complete the entire questionnaire. Please note, if the information you provide is incomplete or the City has questions about your request, we may not be able to fully investigate if we cannot contact you. Once we determine which department should receive you request, it will be entered into our tracking system.

Please Note: (*) indicates required fields.
Contact Information
Address 2:
City, State, Zip Code:*
Alternate Phone:
Email Address

Site Address or Location:
Please enter address/location in the box provided. Please be as specific as possible.
Please enter the details of your request in the box provided.