Report Problem -

Please report your non-emergency issue to the Town of South Coffeyville via the 5-step form below. You may also call city hall during normal business hours, weekdays 8:00 am -5:00 pm. If this is an emergency please contact 911. All received forms will be handled by the respective departments or representatives that the problem pertains to.
Your Contact Information
This will be the information that the Town of South Coffeyville will use to contact you regarding your reported problem.
Name*
First Last
Your Phone Number*
Email*
Address*
Street Address Address Line 2 City State ZIP Code

Type of Problem
Please choose the category or city department that your problem most closely relates to. Only choose one category/department.
Type of Problem*
- Utilities
- Trash Services
- Streets (Lights, Street Signage, Sidewalks, etc.)
- Parks & Recreation (Includes Swimming Pool)
- Business Code Violation (i.e. Signage Violation)
- Issue with City Employee or Contractor
- City Code Violation (i.e. Zoning violation or animal violation)
- Other
Describe Your "Other" Type of Problem*

Details of Your Problem (Time & Location)
In this section you will elaborate on the vital information needed to help the Town of South Coffeyville address your problem.
Date Problem Occurred*
Approximate Time Problem Occurred*

: HH

MM
Where did the Problem Occur?*
Name of City Building Where Problem Occurred*
Name of City Building
Name of City Street or Intersection Where Problem Occurred*
Name of City Street or Intersection
Name of City Park or Rec Facility Where Problem Occurred*
Name of City Park
Name of Local Business Where Problem Occurred*
Name of Local Business
Explain the "Other" Place Where Problem Occurred*

Details of Your Problem
In this section you will elaborate on the vital information needed to help the Town of South Coffeyville address your problem.
Name of City Employee or Contract for Whom Issue Occurred With*
First Last
Please Explain Your Problem Thoroughly*
Avoid using any unnecessary harmful or discriminatory language regarding individuals or local businesses.
Your Desired Solution to the Problem*
There is no guarantee that this solution will be implemented, but this will help the city in the conflict resolution phase with you and other parties involved in the conflict.
Upload Supporting Photos
Upload any photos that accompany your issue and will help with the resolution of the problem.
Drop files here or
Upload Supporting Documents
Upload any documents that accompany your issue and will help with the resolution of the problem.
Drop files here or

Sign Form for Submission
By signing this form you're hereby verifying that all information provided to the Town of South Coffeyville Oklahoma within this form is accurate to the best of your knowledge. Any content provided within this form (i.e. documents, photos, statements, etc.) are hereby released to the Town of South Coffeyville Oklahoma for the use of resolving this problem.
Enter Your Name*
First Last
Best Way to Reach You*
Years Lived in the Town of South Coffeyville*
I hereby verify that everything I provided within this form is accurate to the best of my knowledge.*
- I Agree
Name
This field is for validation purposes and should be left unchanged.

Report Problem