City of Belen, The Hub City

Street, Sidewalk, Pothole, Traffic Light Outage Notification Form

Use this form to report a street, sidewalk, pothole, or traffic light outage within the City of Belen. Please complete all information including your name, phone number and e-mail address so that someone from our staff can contact you if necessary. This information will be forwarded to the appropriate department as soon as it is received.
Date:
Name:
Address:
Phone Number:
E-Mail Address:
Would you like to be contacted?: Yes No
Type of Problem: Sidewalk
Street Repair		 Pothole
Light Outage
Location of Problem:
Describe the Problem: