City of Louisiana Request Form

City of Louisiana Request Form
Routing *

Mayor City Administrator Police Chief Code Enforcement
Full Name *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Category *

Other Streets Water Waste Water Grounds Code Enforcement Building Inspection Public Safety/Police Fire Administrative City Council Judicial/Court
Location
Request *
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The area below is for City Use ONLY. It is intended for tracking and response purposes.
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