SUBMIT A FORM

2. 
3. Question for the Mayor/Board of Control Member

   Use this form to send a question, compliment, concern, or an idea to the Board of Control.

   Your name, phone number, and email address are not required, but are helpful should you need a response.

5. Reported location must be within the City of Defiance boundaries.
7. Contact Information
9. First Name
10. Last Name
12. Phone Number
13. Email Address
15. Street Address:
17. Exact Location in question, if applicable
19. Street Name, Address or Block Number
21. Nearest Two Cross Streets
23. Your Question, Compliment, Concern, or Idea?*
25. 
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field