2. Your Information
   Please complete the form below to submit an online code violations to the Code Enforcement Department. (Your name and contact information will be used for information/follow-up purposes only.)
4. Your Name:*
5. Last Name:*
7. Address:*
8. Address Line 2
10. City/Town:*
11. State:*
12. Zip Code:*
14. Phone Number:*
16. Would you like a call back regarding your submission?

    1. Yes

    1. No
18. Email Address:
20. Violation Address/Location:*
22. Violation: (check all that apply)

    1. Outside Storage
    2. Trash/Debris
    3. Graffiti
    4. Other
23. Inoperable/Abandoned Vehicle(s)
    Please provide the following: Make, Model, License Plate # and Vehicle Color.
24. Parking Violations:
    Please provide the following: Make, Model, License Plate # and Vehicle Color.
26. Violation Description:
28. Attachments:
    Please upload only BMP, JPG, JPEG, GIF, PDF, RTF, or TXT files. NOTE: Photos and other attachments will only be used for informational purposes in support of an alleged code violation and cannot be used as evidence in a court action.
30. Return to the Home Page without submitting a form.
    Gila Bend, AZ
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

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