E-Gov Services City of Piqua

Parks & Recreation Request/Issue

WARNING! Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 911.

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Purpose. This form is used to communicate with the Parks & Recreation Department personnel regarding Parks & Recreation Department requests and issues.

* Information is required.

Contact Information

First Name:
Last Name:
Business Name:
Email:
Daytime Phone:	() –
Fax:	() –
Address:
City:
State:
ZIP:

Issue/Problem Location:

* Address:	- Or Other Not Listed -
Unit:

	Provide any additional information on problem location in the box below.

Nature of the Reqest/Issue (please give as much detail as possible) ...

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* Information is required.

Notes:

If you send us a message, you'll receive a Tracking Number allowing you to follow-up with your request, at your convenience.

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