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2. First Name*
3. Last Name
5. Address
7. City
8. State
9. Zip Code
11. Email Address*
13. Phone Number*
15. Type of Concern*
    -- Select One --Broken Playground EquipmentDiscolored Water/Water OdorFire Hydrant Buried in SnowGraffiti/Vandalism - Public ParkMailbox Damaged by SnowplowNew Trash/Recycle Receptacle NeededOvergrown Village TreesPlowing/Snow RemovalPotholeProperty Maintenance - Overgrown/Exterior JunkSidewalk Trip HazardSpeed/Traffic ConcernStreet Light outUnlicensed or Illegally Parked Vehicle, Boat, Trailer on Private PropertyUnregistered. Unlicensed, Illegally Parked Vehicle on Public RoadwayWater Main BreakOther

    The Village does not accept anonymous service requests.  The Village is subject to the Public Records Law of the State of Wisconsin and therefore may be required to disclose this document in response to a public records request.

    Please be aware these are only monitored during regular business hours .  Please allow 24 hours for a response from the department.  If this is an emergency, please reach out to emergency services.

    
    

17. If Other was selected - please describe:
19. Additional details of concern:
21. Photo if available
22. Additional Photo if available
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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