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Pothole Notification Form
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1.
Contact Information
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2.
Pothole Location Information
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Contact Information
Pothole Notification Form
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First Name
Last Name
Phone Number
Address1
Address2
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State
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Pothole Location Information
Pothole Location
*
Please indicate the nearest address and/or intersection of the pothole.
File or Image of Pothole
Attach an image or file of the pothole in question.
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