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2. Illegal Dumping Notification Form
4. Name (Optional)
6. Address of Dumpsite
8. Nearest Cross Street
10. City
11. State
12. Zip Code
14. Phone Number (Optional)
16. Do you wish to remain Annonymous

    1. Yes
    2. N/A
17. Attach Image of Dumpsite (Optional)
19. Thank You for Doing Your Part to Keep Madison County Clean
Leave This Blank:


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

    This field is not part of the form submission.

23. Submit

* indicates a required field