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2. First Name*
3. Last Name*
5. Phone*
7. Email*
9. Type of Issue / Report
   -- Select One --A Good ExperienceCrime Info or LeadsGraffitiHousing Code Violation(s)PotholesSnow Plowing ProblemStorm Water or Drainage ProblemStreetlight ProblemTraffic Speed Problem
11. Problem Location*
    Please explain where this problem has occurred.
13. Description / Message*
    Do you have any other comments or further description?
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