Have a Complaint or Concern?

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____________