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2. To report a pothole, please be as specific as possible including the nearest street address or perhaps telephone pole identification.
4. Name

   If you would like an acknowledgment, please provide your name.

5. Email or Telephone Number

   Please provide contact information to reach you if there are any questions regarding your submission.

7. Location of Pothole *

   Where is the pothole? Please be as precise as possible.

9. Nearest Cross Street or Intersection

   What is the nearest cross street to the location that you are reporting?

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11. 1. Receive an email copy of this form.
12. Email address

    This field is not part of the form submission.

13. Submit

* indicates a required field