Form Center

2. Issue/Concern*
   -- Select One --Damaged MailboxPotholeSign DamagedTraffic Signal IssueRemove Animal from RoadOther
4. Location*
   Please provide specific information about the exact location of the problem, such as county road number or name, nearest cross streets, direction of travel, city, etc.
8. Type of Animal
10. Details*
    Provide as many details about your concern as possible.
14. Claim Information
    Citizens Claim Service Instructions and Liability Claim Form

    Claims: Anoka County is not responsible for the cost related to pothole damage under most circumstances. The county will, however, allow you to present your information by filling out a Liability Claim Form. Someone from the county Risk Management Department will contact you.
18. How Can We Contact You?
    Please let us know how we can reach you by providing information below.
20. First Name
21. Last Name
23. Phone Number
24. Email Address
26. Is there a best day or time to reach you?
    Is there a best day or time to reach you?

    Is there a best day or time to reach you?
28. Address1
30. Address2
32. City
33. State
34. Zip
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field