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5. Contact Information

   Please be sure to include your Name, Address, Phone Number and Email Address so we know how to reach you.  Please note that all main roads fall under the jurisdiction of either Essex County or The State of NJ. We will forward your complaint to the appropriate department with them.  Note that this submission is not monitored 24/7. If you need assistance, call 973-680-4127.  For an emergency, dial 9-1-1. 

7. First Name
8. Last Name
10. Address
12. City
13. State
14. Zip
16. Phone Number
17. Email Address
19. Specify Location*
21. Intersecting Street
23. Description of Problem
25. Photograph or Document Regarding The Problem
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

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