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2. Name (First and Last)*
4. Address1*
6. Address2
8. City*
9. State*
10. Zip*
12. Phone Number*
13. Email*
17. City Council Members*

    Choose the Council Members you wish to send this to:

    1. Mayor Alonzo Jones
    2. Vice Mayor Gary Miller
    3. James Buckner

    1. Larry Campbell
    2. Bryant Hood
    3. Barry Mayo

    1. Sherman Saunders
    2. Lee Vogler
    3. Madison Whittle
21. Subject/Concern*
23. Details*
    Please provide more information on your concerns
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25. 1. Receive an email copy of this form.
26. Email address

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