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Survey/Form Review

Online Service Request Form

Thank you for contacting the Yuma County, Arizona.

Do you know which department you wish to contact? (Not Required)

What is the nature of your request?

Service

Question

Complaint

Please fill out the following fields so that we may contact you in the event we have a question about the information you've provided.

Name:

Address:

City:

State

Zip:

Phone Number:

E-Mail Address:

I would like to be contacted by someone from the Yuma County.

Please include detailed information on the location (including cross streets) of the concern so that we may better serve you.

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