Municipal Checklist Form

Please provide us with the following...

*Fields marked with an asterisk are required

*First Name:  

*Last Name:  

Title:

*Organization:  

*Street Address:  

*City:  

*State:   *Zip:     

Country:

*Telephone:  

Fax:

*Email:  

I am a(n): Elected OfficialVolunteerStaffConsultantOther

If ’Other’ describe:

Contact me by: - select your preference - Phone Email

Check as many as apply

TOWN BUILDINGS
Historic buildings
Town garage
Town hall
Post office
Town library
Community center
Recreation center
Fire station
Police station
Senior housing
School(s)
Other (please describe below)

GENERAL INFRASTRUCTURE
Town roads
Town bridges
Town sewer
Town water
Stormwater management infrastructure
Street lighting
Traffic lights
Sidewalks
Trails and paths
Industrial park
Solid waste facility
Municipally owned electric utility
Brownfield(s) (These are sites that belong to the town that are believed to be environmentally contaminated)
Public transportation
School Buses
Street trees
Open land owned by the town (undeveloped)
Town green
Town forest
Cemeteries
Outdoor recreation facilities (e.g. playing fields, pools, parks, etc.)
Historic assets not elsewhere identified (please describe below)
Energy infrastructure (please describe below)
Other municipal infrastructure (please describe below)

Use this area for additional description(s)