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Comment & Suggestion Form

2. Please use this form to enter a comment or suggestion. Select a category from the list, then a clear description of your comment or questions. You must fill in your name and address. If you wish to be contacted, please include your phone number and/or email address.

4. Notice
   Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.

   Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.

6. Department*
   -- Select One --AdministrationAnimal ControlBuilding & GroundsCommunity DevelopmentCounty ClerkCourtsDrainEmergency ManagementEqualizationFinancial ServicesFriend of the CourtGIS MappingHealth DepartmentInformation SystemsLegalMotor PoolMSU ExtensionParksPersonnelPrinting / MicrofilmingProsecuting AttorneyPublic SafetyPurchasingRegister of DeedsReport Website IssuesResource RecoverySheriffTreasurerVeterans' Services

8. Comments/Suggestions*

10. First Name*

11. Last Name

13. Address*

15. City*

16. State*

17. Zip*

19. Daytime Phone

20. Email*

22. Disclaimer

    The following procedure is provided for your convenience. The County will attempt to address your issue in a timely manner upon receipt. However, the County cannot guarantee an immediate response to your issue through this procedure. If you feel that your issue is of an urgent nature and/or may constitute a threat to health, safety, and welfare, you should contact the County directly at 269-983-7111.

    1. I Agree
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24. 1. Receive an email copy of this form.
25. Email address

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26. Submit

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