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2. Report a Concern in District 3
   Please use the form below if you would like to report a concern to Council District 3. Not sure if you live in District 3? Find out online now.

4. Name*
5. Address*
6. Hamlet*
   -- Select One --CentereachFarmingvilleHoltsvilleLake GroveLake RonkonkomaPort Jeff StationSeldenOther
8. Email Address*
9. Phone Number*
10. Join our mailing list?*

    1. Yes

    1. No
12. Check off as many concerns as you wish and answer all associated questions

    After choosing an option, please wait for questions to load.

    1. Abandoned Home
    2. Business in Home
    3. Flooding
    4. Graffiti
    5. Illegal Renting

    1. Miscellaneous
    2. Missing Sign
    3. Outdoor Storage
    4. Overgrown Park
    5. Pool Issue

    1. Pothole
    2. Property Maintenance
    3. Speeding
    4. Street Sweeping
    5. Streetlight

    1. Sump Maintenance
    2. Tree
    3. Vehicle
    4. Waste Management / Reycling
14. Address of the Abandoned Home
15. Is the abandoned home boarded and secured?

    1. Yes
    2. No
17. Does this home have broken windows?

    1. Yes
    2. No
18. Does the abandoned home have squatters?

    1. Yes
    2. No
20. Notes About the Abandoned Home
22. The dates and times the business is/are running is/are
23. What type of business it?
24. Do customers arrive at this business?

    1. Yes
    2. No
26. Do employees arrive at this business?

    1. Yes
    2. No
27. When do the transactions of this business occur?
29. Does this business have outdoor storage?

    1. Yes
    2. No
30. Notes About the Business out of a Residence
32. Location of the Flooding
33. Is there currently a basin at the location?

    1. Yes
    2. No
35. Upload an Image of the Flooding
36. Notes About the Flooding
38. Where is the graffiti?
    -- Select One --BusinessHouseParkSignOther
39. Address or Intersection of the Graffiti
41. Upload an Image of the Graffiti
42. Is the graffiti re-occurring?

    1. Yes
    2. No
44. Is the home owner occupied?

    1. Yes
    2. No
45. Is the extra occupancy of this home in an attached or detached area of the home?
    -- Select One --AttachedDetached
47. Where is the extra entrance?
48. What are the times of the illegal apartment extra occupancy or times of their entrances and exiting patterns?
50. Where do the additional occupants park their car?
51. What is the make/model of the additional occupant's car?
52. Estimated amount of people living in the apartment?
54. Location of the Miscellaneous Issue
55. Upload an Image of the Miscellaneous Issue
57. Notes
59. Address of Missing Sign
60. What type of sign is it?:
62. Upload an Image of the Sign Location
63. Notes About the Missing Sign
65. What is the address where the outdoor storage is taking place?
66. What type of structure is the outdoor storage?
68. Location of the Park
69. Upload an Image of the Overgrown Park
70. Notes About the Overgrown Park
72. Address of the Home with a Pool Issue
73. What type of pool is it?
    -- Select One --Above GroundIn Ground
74. Is the yard with the pool fenced in?

    1. Yes
    2. No
76. Is the pool fenced in?

    1. Yes
    2. No
77. Estimate Date of When the Pool Was Installed
    Estimate Date of When the Pool Was Installed
78. Notes About the Pool
80. What is the address or intersection of the pothole?:
81. Please Enter Work Order if Applicable
82. Upload an Image of the Pothole
84. What is the address of the location that needs property maintenance?
85. What type of property is the location that needs property maintenance?
    -- Select One --BusinessProperty
86. Does the property that needs maintenance have tall grass?

    1. Yes
    2. No
88. Does the property that needs maintenance have litter?

    1. Yes
    2. No
89. Upload an Image of the Needed Property Maintenance
90. Notes About the Property Maintenance
92. Location of the Speeding
93. Time of Day of the Speeding
95. Location of the Street Sweeping
96. Upload an Image of the Street Sweeping
97. Notes About the Street Sweeping
99. What is the location of the streetlight?
100. Is the streetlight out?

     1. Yes
     2. No
102. Is the streetlight always on?

     1. Yes
     2. No
103. Upload an Image of the Streetlight
105. Address or Intersection of the Needed Sump Maintenance
106. What sump maintenance needs to be done?
108. Upload an Image of the Sump Maintenance
109. Notes About the Sump Maintenance
111. Address of the Tree
112. Is the tree dead?

     1. Yes
     2. No
113. Does the tree have an orange X marked on it?

     1. Yes
     2. No
115. Please Enter Work Order if Applicable
116. Upload an Image of the Tree
118. Is the vehicle registered?

     1. Yes
     2. No
119. Where on the property is the vehicle?
120. Is the vehicle covered?

     1. Yes
     2. No
Leave This Blank:


122. 1. Receive an email copy of this form.
123. Email address

     This field is not part of the form submission.

124. Submit

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