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Report A Street Cleansing Problem
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Please enter your title
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Forename
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Middle name/Initials
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Surname
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Building/house name/number
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Street address
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Town Name
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County
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Postcode
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Tel Number (include area code)
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Email
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Fax
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Location of the problem
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Road / Street / footpath name
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Date of Observation
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Description of the problem (Street litter, litter bins or dog bins)
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Data Protection Act 1998
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Data Protection Act 1998
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Submitting your form
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Reference Number
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NOT SUBMITTED YET
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Date Of Submission
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NOT SUBMITTED YET
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