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Report a Pothole

2. Pothole Address*
4. Additional Information
6. First Name*
7. Last Name*
9. Phone Number*
10. Email Address
12. Upload a Photo
    Use this to upload a photo of the pothole.
Leave This Blank:


14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

* indicates a required field