2. The Perry Township Report a Concern Form will help us identify a road or zoning problem in your area.

   
   

   If you want to report potential criminal activity, please use the Police Department's tip line: https://www.perrytwp.org/FormCenter/Police-Forms-4/Perry-Township-Crime-Tips-49

   Thank you for your assistance!

4. Contact Information

   Fields may be left blank for anonymous submission. By providing contact info, you allow our staff to contact you to in order to investigate any concerns further. 

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

    1. Loose / protruding manhole cover
    2. Overhanging trees / shrubs
    3. Pothole
    4. Road striping
    5. Storm sewer leaking / blockage
    6. Street lights

    1. Traffic signals
    2. Traffic / road signs
    3. Water leaking on roadway
    4. Water leaking
    5. 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

* indicates a required field