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Use this form to report a mosquito problem within the City of Belen.

Please complete all information including your name, phone number and e-mail address so that someone from our staff can contact you if necessary. This information will be forwarded to the appropriate department as soon as it is received.

Date:
Name:
Address:
Phone Number:
Email Address: 
Would you like to be contacted?
Enter the nearest street address or intersection of the mosquito problem:
Describe the Problem: