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2. Disclaimer

   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.

4. Jefferson County Online Contact Form
   To contact Jefferson County by email, please complete the online form provided below. We welcome your questions, comments and suggestions. Responses are provided during business hours. Please visit departments and offices' pages for their hours of operation (www.jeffco.us/221).
6. Name*
8. Email*
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9. Phone Number
11. Do you think you have a website technical or ADA/accessibility issue?
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    Please only select this drop down if you feel you are experiencing one of these issues on the website, otherwise it may take additional time to address.

13. Comments or Questions*
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