Skip to Main Content
Loading
Close
Loading
Emergency Alert
Mandatory 20 Percent Reduction in Water Use and Restrictions in Effect
Read On...
COVID-19 Health Orders in Effect
Read On...
Government
Departments & Services
Community
Business
Visitors
How Do I...
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
CIRO
City Clerk's Office
Commercial Loading Zone Permit
Community Engagement
CPA
Emergency
Finance Department
Housing and Community Services
Information Technology
Planning and Economic Development
Police Department
Recreation & Parks
Santa Rosa Water
Transportation & Public Works
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
Glass Fire Recovery - Add Your Contact info
This form has been modified since it was saved. Please review all fields before submitting.
Home Street Address
*
The street address for your home impacted by the Glass Fire
First Name
*
Last Name
*
Email
*
Current Street Address
*
Street Address 2
City
*
State
*
Zip
*
Phone 1
Phone 2
Leave This Blank:
Submit
* indicates a required field
Privacy Policy
Website Policy
Social Networking
Email Notifications
Emergency & Preparedness Information
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow
