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Report a Pothole

2. Name

4. Where is the pothole?*

6. Add pictures or attachments to your request

8. How would you like us to contact you?

   Please provide the necessary contact information below.

   1. By Phone
   2. By Email
   3. Do not contact me
10. Phone

11. E-Mail

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13. 1. Receive an email copy of this form.
14. Email address

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15. Submit

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