Community Code Violation Submission Form

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.)

   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

Leave This Blank:


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

* indicates a required field