Fields marked with * are required.
Please submit the form only one time for each issue. If you encounter any problems submitting the form, please contact us at dot.info@wv.gov.
Use this field to provide information to help us find the location in your request. Examples include nearby buildings or structures.
Use the map to find the location of the request. Clicking the map will drop a marker and update the GPS Latitude, Longitude. (Don't worry if you drop a marker accidently, the GPS Latitude, Longitude will update with every click)