Enter Request
Name (last, first)*
What is the request, concern or complaint about?*
Where is the concern or issue?*
How are you affiliated with the County?*
E-mail Address
Do you want someone to follow up with you?*
What is the best way to contact you?*
(*) Required Fields

Using the TAB key or Mouse cursor to move to the next field, please fill in the blanks or select the most appropriate response from the drop down list, if available. Otherwise, leave the default values provided, as is. If you want to check status of your request, please print the page after the request is submitted, and keep it or write down the REQUEST NUMBER for future reference.