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2. Graham County Engineering------*928-428-0410------Use this form to report road hazards or flooding violations.

4. Complainant's First Name:*
5. Complainant's Last Name:*
6. Today's Date:*
   Today's Date:
8. Physical Address:
10. Phone Number and/or Email Address:*
12. Nature of Complaint/Request:*
14. Possible Violator's Name and Address:
15. Parcel Number:
    List parcel number of property.
17. Results from on-site visit (Internal Use Only):
19. Follow-up with complainant/action to be taken (Internal Use Only):
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

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