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Please Fill Out a Citizen Service Request Form
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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____________ |
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