Please answer the following questions completely and return the form with as much details as possible.

What is your name?*

What is your address?*

What is your email address?*

1. Is the initial pipe still in the ground? Y/N/Don’t Know*

2. Is the initial pipe outside the easement? Y/N/Don’t Know*

3. If yes, do you want? it removed, left in the ground (abandoned), currently undecided

4. If undecided, what are your concerns:

5. Do you believe the final AT&T conduit with fiber is not within the easement? Y/N/Don’t Know*

6. Are there any outstanding restoration issues? If yes, explain.

7. Is there anything else you would like to bring to the City’s attention?

To be determined items:

The City realizes there is not yet answers on the following items:

1. What methods will be used for removal.
2. If trees are damaged, how will those be handled.
3. What, if any, restrictions need to be filled.

Please give completed forms to the City by Noon on Friday, August 31st. Completed forms can be emailed to citymanager@rochestermi.org, dropped off at City Hall, faxed to (248) 651-2624, or submitted electronically.