2. Are you an employee of Lucas County or a member from the community?*

   1. Employee
   2. a member of the community
4. Please provide your feedback here:*
6. Do you want our office to follow-up with you?

   1. Yes
   2. No
8. First & Last Name
10. Contact Phone
12. Email Address
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14. 1. Receive an email copy of this form.
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16. Submit

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