Citizen Service Request

Copy this page and print it off on your computer.

Please Fill Out a Citizen Service Request Form

   

City of Spencer

 

Citizen Service Request 

   Date Received: _____________________

 Type of Request

   General Information__________________  Code Enforcement              
   Name of Citizen_____________________  Police
   Street Address______________________

  City__________State_______ Zip Code______

 Animal Control
  Day Phone_________________________ Utility Authority
 Evening Phone_______________________  Street
 Email Address_______________________  Fire Department
   City Clerk

 

  Descripton of Concern

 

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 

Received By & Submitted To

 

 Employees Name________________________  Date of Receipt_________________________
 Department Head________________________  Date of Receipt_________________________

 

Action Taken

 

 _____________________________________  ________________________________________
 Submitted By: __________________________  Date____________