Clean City Graffiti Report Form

Clean City Graffiti Report Form

Date you noticed the graffiti:
Address/location (ex: "43 Broadway" or "City Hall"):
Specific location (ex: on the face of the building):
Is this City property or private property?	City: Private: Not Sure:
Have you reported the graffiti to the police?	No: Yes:
Any other details you would like to provide: Contact information - this will remain confidential with the Clean City Program. We may need to contact you regarding the graffiti but will not use your name or information for any other purpose.
Name:
Business affiliation (if any-optional):
Address (optional):
City (optional):
Phone:
E-mail address (optional):