Concern/Comment/Questions

119 Cemetery Street, PO Box 339

Clifford, PA 18413

570-222-9364

Clifford Township

Concern Or Request Form

Two options: either complete the e-mail form below, or download a request form to mail in.

Please complete the information requested to submit your concern. Completed forms will be forwarded to the proper official for resolution or reviewed by the Board of Supervisors. Incomplete forms may not be able to be processed.

In the text box below, please answer the following questions:

1) Where is the activity or situation occurring? (road name, distance from nearest intersecting road)

2) What or whom is causing this activity or situation?

Date *

Response requested:

Option 1: No response necessary

Option 2: Respond by e-mail

Choose

Option 1: To be kept confidential

Option 2: To be forwarded to supervisors

Option 3: Forward to appropriate department official

Name: *

Email: *

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Subject: *

Message: *