2. 

4. Thank you for helping to keep Aurora a safe community for all. Complete the following information to report illegal fireworks in the community.

6. First Name*
7. Last Name*
9. Address*
11. City*
12. Zip Code*
14. Email Address*
16. Phone Number*
18. Date of Illegal Fireworks Use*
20. I witnessed an individual perform the following violations of the City Code (Check all that apply)*

    1. Possess
    2. Explode
    3. Ignite
    4. Discharge
    5. Fire
    6. Otherwise use or display fireworks, flame effects, consumer fireworks, or any other pyrotechnic
22. Address or General Area of Illegal Use*
24. Specifically on the aforementioned date, I witnessed the following actions:*
26. I am submitting the following evidence
28. Photo
29. Video
31. Photo
32. Video
34. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) the statements set forth are true and correct, except as to matters therein stated to be on information and belief and, as to such matters, I certify, as aforesaid, that I verily believe the same to be true 2) I am over the age of eighteen (18) and competent to attest to the facts state therein, 3) the evidence submitted accurately depicts what I observed/heard, and 4) Should I be called to testify regarding my knowledge of the facts herein stated, I would be able to do so.

    1. I agree.
36. Electronic Signature
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field