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Citizen Assessment Form

  1. Use this form to request or report the following: flood damage, fallen trees, hazardous sidewalk condition, City street or gutter drainage problems; street sign issues, traffic signal outage, streetlight outage (provide streetlight pole number). Your name, address, and telephone number are required, and are helpful should questions arise.

  2. Reported location must be within the City of Port Arthur Boundaries. The exact reported location/site address is required

  3. Please use one form per household!

  4. Contact Information

  5. Assessed Damage:

  6. Check All That Apply:

  7. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) my application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, I authorize my electronic signature to be valid and binding upon me to the same force and effect as a handwritten signature, 3) I grant permission for a City of Port Arthur Inspector to enter my property to assess damages sustained by the September 19, 2019, Flash Flooding event, and 4) I may still be required to provide a traditional signature at a later date.

  8. Leave This Blank:

  9. This field is not part of the form submission.