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2. Account Number
3. Cart Number
5. Service Address
7. Dear Valued Resident
   Please complete this form and contact the City of Zephyrhills Police Department at 813-780-0050 to file a report. Failure to return this form within 14 calendar days will result in a one-time fee of $60 for the cost of the container, delivery, and processing. Please contact our office for additional information, or if you feel this information is inaccurate. You can contact the Sanitation Department by calling 813-780-0022 or emailing publicworksrfa@ci.zephyrhills.fl.us. Respectfully, Shane LeBlanc, Public Works Director.
9. Police Case Number
11. Your Statement About Your Cart
13. Electronic Customer Signature
    Please be advised that by signing this document you are certifying that your statement is true.
14. Date
    Date
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16. 1. Receive an email copy of this form.
17. Email address

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18. Submit

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