The Office of Councilman Kaleem Shabazz, 3rd Ward.
Constituent Concern Form
Name *
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Street Address *
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Contact Phone Number *
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Email
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Have you contacted another department within the city regarding your complaint? *
If yes, please give the name of the department and the person(s) with whom you worked.
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Explanation of complaint *
Please include all relevant information (Dates, locations, etc)
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How may our office assist you? *
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