2. The Perry Township Report a Concern Form will help us identify a problem in your area. Should a problem require urgent attention, please call us immediately at 889-2669. For a police emergency, dial 911.
   
   Thank you for your assistance!
4. Contact Information

   Fields may be left blank for anonymous submission. Contact information provided is confidential and only used to further investigate reported concerns.

6. First Name
7. Last Name
9. Street Address
11. Phone Number
12. Email Address
14. Please indicate the nature of your problem by checking the appropriate box(es) below:
16. 1. Abandoned vehicles
    2. ADA complaint
    3. Blocked drainage channel
    4. Chemical discharge
    5. Damaged curb
    6. Damaged sidewalk
    7. Discrimination complaint
    8. Dogs barking

    1. Fair housing complaint
    2. Hazardous parking
    3. Litter
    4. Loose / protruding manhole cover
    5. Noise nuisance
    6. Overhanging trees / shrubs
    7. Pothole
    8. Road striping

    1. Storm sewer leaking / blockage
    2. Street lights
    3. Traffic signals
    4. Traffic / road signs
    5. Water leaking on roadway
    6. Water leaking
    7. Weeds
18. Brief Description of Problem (or other problem(s) not listed)
20. Location of Problem
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

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