Form Center

2. Have a Question?
   Fill out the form below for general comments, compliments and questions.
3. Have a Problem?
   REPORT A PROBLEM

   Use the REPORT A PROBLEM link above to report a problem or concern.
4. Need to Call or Visit?
   Staff Directory

   Use the staff directory link above for phone numbers and addresses
6. EMERGENCIES:
   In the event of an emergency or urgent matter, please do not use this form. Call 911 for emergencies.
7. DEPT. OF PUBLIC WORKS:

   For all questions, comments or problems related to DPW (roads, potholes, tree, snow/ice, brush, leaves, etc.), please use the REPORT A PROBLEM link above.

   To report a missed curbside garbage, recycling or bulk collection, please click here.

9. First Name*
10. Last Name*
12. Email Address*
14. Street Address*
16. Neighborhood*
17. Zip Code
19. Phone Number
21. Subject*
23. Department*
    -- Select One --Animal ControlBingo & RafflesBoards and CommissionsBuilding and InspectionsCode EnforcementCommunicationsCommunity DevelopmentCrossroads at the Lincroft AnnexElection ServicesEmergency ManagementEngineeringFinanceFireFire PreventionFirst AidHealth DepartmentLandmarks CommissionLiquor LicenseMiddletown Municipal TVMiddletown Public LibraryParking PermitsRecreationPassport ServicesPlanningPolice - NON EMERGENCIES ONLY For emergencies call Police Desk 732-615-2100 or 911Public WorksSenior CenterSocial ServicesTax AsssesmentTax CollectionTownship AdministrationTownship ClerkTownship Committee (all)Township Committee - Tony Perry, MayorTownship Committee - Rick W. Hibell, Deputy MayorTownship Committee - Ryan M. Clarke, Township CommitteemanTownship Committee - Kimberly Kratz, Township CommitteewomanTownship Committee - Kevin M Settembrino, Township CommitteemanVital StatisticsWebmaster

    Select the department you wish to contact.

25. Reason For Contact*
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field