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2. Full Name*
3. Email Address
5. Blight Address*

   Address where the blight is located.

7. Mailing Address

   If different from the Blight Address.

9. City
10. State
11. Zip Code
13. Phone Number*

    Required so we can follow up with any questions.

14. ICR # or Case Number

    Found in the upper right corner of your original notice.

16. Photos

    You can upload photos to speed up the process.

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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field