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2. First Name
3. Last Name
5. Email Address
6. Phone Number
8. Address
10. City
11. State
12. Zip Code
14. Please provide the full address of the property of concern
16. Briefly describe why the property is blighted
18. To the best of your knowledge is the property vacant?

    1. Yes
    2. No
20. Please provide any photos of the property
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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