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2. Name*
3. Email Address*
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
13. Comment/Question
15. Code Violation Information
17. Code Violation Address
19. City
20. State
21. Zip Code
23. Violation Summary

    Please describe the code violation

25. Code Violation Picture

    If you have any pictures of the violation, please upload them here. 

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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

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