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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