CITIZEN REQUEST FORM

Thank you for submitting your request, it will be handled on reception and studied as soon as possible.

Fields marked with an asterisk (*) are mandatory. This information is required to contact you or to confirm your request number, if needed.

1. Requester
*First name
*Last name:
*Tel. home
Address
*City
*Postal code
*E-mail address
Tel. work
Cellular
Other
Fax
2. Description of the request
Location
Number
Street
Fraction


*Description of the request

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