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Highway Department Issue/Concern Reporting

2. Issue/Concern*
   -- Select One --Damaged MailboxPotholeSign DamagedTraffic Signal IssueRemove Animal from RoadOther

4. Location*

   Please provide specific information about the exact location of the problem, such as county road number or name, nearest cross streets, direction of travel, city, etc.

8. Type of Animal

10. Details*

    Provide as many details about your concern as possible.

14. Claim Information
    Citizens Claim Service Instructions and Liability Claim Form

    Claims: Anoka County is not responsible for the cost related to pothole damage under most circumstances. The county will, however, allow you to present your information by filling out a Liability Claim Form. Someone from the county Risk Management Department will contact you.

18. How Can We Contact You?
    Please let us know how we can reach you by providing information below.

    Please let us know how we can reach you by providing information below.

20. First Name

21. Last Name

23. Phone Number

24. Email Address

26. Is there a best day or time to reach you?
    Is there a best day or time to reach you?

    Is there a best day or time to reach you?

28. Address1

30. Address2

32. City

33. State

34. Zip

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field