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2. POT HOLE REPORT FORM
4. Fill in this simple form to notify the Public Works Department of potholes in Le Mars.
6. First Name*
7. Last Name*
9. Email Address*
10. Phone Number*
12. Please tell us the approximate location of the pothole(s).*
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14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

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