Request Form 2

1. The City of Lima Request Form will help us identify a problem or request you may have. We will direct your request to the proper department. Should a problem require urgent attention, please call us immediately. For a police or fire emergency, dial 911. Otherwise, call (419) 228-5462(LIMA).
   Thank you for your assistance!

   Thank you for your assistance!

2. Contact Information

3. First Name*

4. Last Name*

5. Address1*

6. Address2

7. City*

8. State*

9. Zip*

10. Phone Number*

11. Email Address*

12. Please indicate the nature of your problem by checking the appropriate box(es) below:

13. 1. Pothole
    2. Damaged curb
    3. Traffic signals
    4. Weeds
    5. Dogs barking
    6. Abandoned vehicles
    7. Chemical discharge
    8. Water leaking

    1. Litter
    2. Road striping
    3. ADA Complaint
    4. Blocked drainage channel
    5. Street Lights
    6. Damaged sidewalk
    7. Traffic/Road signs
    8. Overhanging trees/shrubs

    1. Noise nuisance
    2. Hazardous parking
    3. Storm sewer leaking/blockage
    4. Water leaking on roadway
    5. Water in Basement
    6. Loose/protruding manhole cover
    7. Discrimination Complaint
    8. Fair Housing Complaint
14. Brief Description (or other problem not listed)

15. Location of Problem*

    You must enter a location of the problem

Leave This Blank:


16. 1. Receive email copy
17. Email address

18. Submit Submit and Print

* indicates a required field