Requests for the Mayor - North Miami, FL

Constituent Services Request Form

Name

Communications Method

Date Constituent Presented Issue

Intake Staff Member's Name (If Applicable)

Constituent's First Name

Constituent's Last Name

Constituent's Email

Address

City

Zip Code

District #

Phone number

Description of constituent’s issue

Other agencies contacted by constituent and their responses

Actions taken by this office (dates, names, phone numbers of contacts; information/results obtained)

Date and method of response to constituent

Was constituent’s issue successfully resolved?

Date the constituent’s issue resolved?

When was Mayor Desulme notified?

City Department Involve (If Applicable)

Mayor's Staff Internal Comments