Citizen's Concern Form

2. First Name

3. Last Name

5. Phone Number

6. Email*

8. Address

10. City*

11. State

12. Zip

14. Please describe your concern*

    This form is one way for you to share your concern. Fill in as much information as you can. Someone will get back to you.

16. Other Dania Beach Forms Available:

    http://daniabeachfl.gov/2640/Send-a-form

    Code Violation Complaint | Permit Information Request | Public Records Request | Public Services Issues Notification | Request a Lien Search | Zoning Inquiries

18. Upload File

20. NOTE

    Please note that all information provided is public information subject to Florida Law.

    Please note that all information provided is public information subject to Florida Law.

Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field