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2. Name*
3. Email*
5. Phone Number*
6. Address*
8. Location of Concern*
   Enter nearest address, intersection, landmark
10. Description of Concern*
12. If you'd like to upload a photo, you may do so here
13. If you'd like to upload a photo, you may do so here
15. Please Note:
    The Jefferson County Highway Department does not maintain State highways, city or town streets. Thank you for submitting your road concern. The Highway Department will take your concern under advisement.
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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

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