The Town of Enfield, Connecticut

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3/11/2010:

Public Safety Subcommittee

3/15/2010:

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Citizen Request Form

If this is an emergency, call 911. Please do not complete this form.

Thank-you for submitting a service request to the Town of Enfield. A member of the
Town Staff will address your request as soon as possible during regularly scheduled
work hours (M-F, excluding holidays).

Please be sure to include your email address and check the box, ‘I would like to be notified

by email of updates to this request,’ on the form below to receive status updates on the
progress of your request.

Your Information

First/MI.:

Last Name:

Address:

Address 2:

City:

State:

Zip:

Phone:

Ext.:

Alt. Phone:

Ext.:

Email:

Request Details

City:

Street #:

Street:

select

Cross St:

select

Request Type:

Comments:

Attach files or documents:

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Current file attachments:

I would like to be notified by email of updates to this request

I would like to be notified by mail of updates to this request

I would like to be notified by phone of updates to this request

Please visit the Town Contact Page (http://www.enfield-ct.gov/content/686/3778.aspx)
to connect with a specific Town Department if you require additional follow-up with your request.

With the exception of requests for streetlight repairs, if you do not receive a response from

Town Staff via Q-Alert or e-mail, within 5 business days from when you submitted your

service request, please contact Enfield Assistant Town Manager Dan Vindigni at
AsstTownManager@enfield.org. If possible, please include your Service Request number.

Page Updated: 12/29/2009 3:00:08 PM