Citizen Request Form – Keith County NE

Name
This field is for validation purposes and should be left unchanged.
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Is Kiosk Request?
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Status
What is being Requested?*
Category of Request*
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Geocoder
Add an Address
Map
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Coordinates
Specific Location*
Example: Room 202, back left corner, etc.
Additional Details of the Request
Upload File/Picture
Drop files here or

Max. file size: 20 MB, Max. files: 10.
Requesting Department*
Requester Name
Requester Phone
Requester Email

You will be updated via email.

If you have any questions about the use of this form please email facilities management at facilitiesadmin@mycity.org