Create a Website Account - Manage notification subscriptions, save form progress and more.
230 W. Main StreetPurcell, OK 73080(405) 527-6561
Date Received: _____/_____/__________
Received by: _____________________________
Forwarded To: ____________________________ Name / Department
The City of Purcell is an Equal Opportunity Provider and Employer. In accordance with Federal law and the U. S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color national origin, sex, age or disability. (Not all prohibited bases apply to all programs.) To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W. Washington, D.C. 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD 711)
This field is not part of the form submission.
* indicates a required field