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2. Type of Issue*

   Please choose one of the following.

   1. Housing Conditions
   2. Food/Restaurants
   3. Other
4. Location of the Issue*

   Where did the problem occur?

6. Description of the Issue*

   Briefly describe the problem.

10. Your Name*
12. Your Phone Number*
14. Your E-mail
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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

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