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Citizen Request Form

If you are experiencing an emergency situation,
Dial 9-1-1, immediately.

This form is for citizens of Cullman County to report issues directly related to County Commission service (road repairs, information requests, appreciation, complaints) and is not intended for emergency situations. All other business should be conducted via County Commission meetings and you may contact the Commission Office to request being placed on the agenda.

*All information fields are required for any Citizen Request Form submitted. Incomplete forms will not submit and will not be considered.

Personal information: First Name:

Last Name:

Email:

Telephone:

Address 1:

Address 2:

City:

 
State: 
 
Zip Code:


Your Request