2. Perry Township Report a Concern Form

   The Report a Concern form is for members of the public to notify Perry Township staff of potential issues and concerns in the township including but not limited to:

   • Hazards on or damage to Township roadways
   • Stormwater drainage systems
   • Zoning and exterior property maintenance concerns

   If you want to report potential criminal activity, please use the Police Department's tip line: https://www.perrytwp.org/FormCenter/Police-Forms-4/Perry-Township-Crime-Tips-49

   Thank you for your assistance!

4. Contact Information

   Completing the contact information fields is optional. However, by providing contact info, Perry Township staff will be able to contact you for follow-up and conduct additional investigation into your concern, if needed.

6. First Name
7. Last Name
9. Street Address
11. Phone Number
12. Email Address
14. Please indicate the nature of your problem by checking the appropriate box(es) below:
16. 1. Abandoned vehicles
    2. ADA complaint
    3. Blocked drainage channel
    4. Chemical discharge
    5. Damaged curb
    6. Damaged sidewalk

    1. Loose / protruding manhole cover
    2. Overhanging trees / shrubs
    3. Pothole
    4. Road striping
    5. Storm sewer leaking / blockage
    6. Street lights

    1. Traffic signals
    2. Traffic / road signs
    3. Water leaking on roadway
    4. Water leaking
    5. Weeds
    6. Other (Please describe in the box below)
18. Brief Description of Problem (or other problem(s) not listed)
20. Location of Problem
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field