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2. Requested Section of Street*
4. Name of Individual, Family, Group or Organization*
6. Address1*
8. City*
9. State*
10. Zip*
12. Phone Number*
13. EMail Address*
15. Agreement*

    We agree to conduct clean-ups in the adopted location at least quarterly (4 times per year) with an annual renewal. Notification will be given to Public Works prior to the clean-up.

    1. Agree
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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field