Citizen Service Request

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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____________