Form Center

2. Lake Wales E-mail Message Form
4. To: Daniel Williams, Commissioner Seat 2 / District 19
6. First Name*
   Enter your First name
7. Last Name*
   Enter your last Name
9. Email Address
   Enter your Email address (Optional)
11. Phone Number
    Enter your phone number (optional)
13. Subject*
15. Body*
    Type your message here
17. Would you like a reply?

    1. A reply is requested
    2. A reply is unnecessary
19. Notice:
    Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing. Also, please be aware that all e-mail communications to city officials and employees become part of the public record and are subject to public review as well as the record retention requirements of the applicable Florida statute.
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field