Citizen Service Request

A Citizen Service Request form may be submitted regarding city streets, trash complaints, unsafe buildings, etc. The submitted information will be directed to the appropriate department by Kirksville City Hall. If you choose to receive updates regarding your request, please fill out ALL information below.

Required fields are marked with a red asterisk ( * ), if this information is not submitted your request may not be processed correctly. When the form is filled out correctly you will be redirected to a confirmation page.

If your comment does not accurately fit into one of the categories listed below, please e-mail pubinfo@kirksvillecity.com and the information will be relayed to the appropriate department.

Please supply the following information:

Your Name:

Your Address:

Your Telephone Number:
   *

Your E-mail Address:
   *

Address Where Service is Requested:
   *

Type of Service Requested

Ditches & Culverts- not draining properly Sewers- backing up, odors, etc.

Streets- potholes, curbs, etc Streets/Alleys- needing to be bladed or rocked

Street Signs- needing replacement or repair Streets- drainage problems

Traffic Signals- needing repair or new bulbs Trash or junk needing removal

Trees- needing to be cut down or trimmed Weeds & Grass- needing to be cut

Unlicensed or junk vehicle Unsafe Building

Please use the space below to supply additional information:

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

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

**If you would like to be notified of updates, please fill out all information above.

Your Name:
Your Address:
Your Telephone Number:	*
Your E-mail Address:	*
Address Where Service is Requested:	*


Type of Service Requested

Ditches & Culverts- not draining properly	Sewers- backing up, odors, etc.
Streets- potholes, curbs, etc	Streets/Alleys- needing to be bladed or rocked
Street Signs- needing replacement or repair	Streets- drainage problems
Traffic Signals- needing repair or new bulbs	Trash or junk needing removal
Trees- needing to be cut down or trimmed	Weeds & Grass- needing to be cut
Unlicensed or junk vehicle	Unsafe Building

Please use the space below to supply additional information:


I would like to be notified by e-mail of updates to this request**
I would like to be notified by phone of updates to this request**
If you would like to be notified of updates, please fill out all information above**.

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