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2. The City of Havelock Submit a Concern Form will help us identify a problem in your area -- and fix it fast.

   Thank you for your assistance!

4. Contact Information
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number*
18. Email Address*
20. Please, indicate the nature of your problem by checking the most appropriate box(es) below:
22. *

    1. Pothole
    2. Damaged curb
    3. Traffic signals
    4. Weeds
    5. Dogs barking
    6. Abandoned vehicles
    7. Chemical discharge

    1. Water leaking
    2. Litter
    3. Road striping
    4. ADA Complaint
    5. Blocked drainage channel
    6. Street Lights

    1. Damaged sidewalk
    2. Traffic/Road signs
    3. Overhanging trees/shrubs
    4. Storm sewer leaking/blockage
    5. Water leaking on roadway
    6. Loose/protruding manhole cover
24. Brief Description (or other problem not listed)
26. Location of Problem
Leave This Blank:


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

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field