Citizen Concern Online Form

Please fill out this form if you have a concern that you feel the City should be aware of, such as a Code Violation. (The following are some examples of Code Violations: noise complaints, unlicensed or unleashed dogs, and weeds in excess of 12 inches.)

Please note that all required fields, noted by an asterisk, must be completed before the City of Elko New Market will investigate any City Code Violation.

Please read the Data Privacy Advisory before submitting this form.

Your Contact Information:
Please provide your contact information in this section.

Name *

Street Address *

City, State, Zip *

Phone Number *

Cell Phone Number

E-mail Address

Concern Details Section:
Please provide the details regarding your concern in this section. Provide as much detail as possible.

Please enter the date that the concern occurred (if applicable):

Date of Concern (if applicable)

Type of Concern *

Details of Concern (Provide as much detail as possible) *

Address (or Location) of Concern. (Enter N/A here if concern is not related to a property address or specific location) *

Property Owner Name (if known/applicable)

Phone Number of Property Owner (if known/applicable)

If you would like the City to keep you updated on the status of this matter, please choose one of the following options Contact me by the phone number provided above.
Contact me by the e-mail address provided above.

Signature Box * By checking this box, I agree that I have read the Data Privacy Advisory above and all information I have provided on this form is accurate and complete.

* - denotes required field