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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____________