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2. Subject*
4. Message*
6. Name
8. Address
9. Address Line 2
11. City
12. State
13. Zip Code
15. Name of Company
16. Email*
17. Phone

19. Under Florida law, e-mail addresses are public records. If you do not want the contents of this form (including your e-mail address) released in response to a public records request, do not use this form. Instead, contact this office by phone or in writing. Please be advised that most records received and maintained by the City of Jacksonville Beach are public records and subject to the disclosure provisions of Sec. 119.07, Florida Statutes.

    Please do not use this form to submit a public records request; rather, click here.

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

    This field is not part of the form submission.

23. Submit

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