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2. First Name*
3. Last Name*
5. Town Department or Board/Commission*
7. Email Address*
9. The following questions are optional:
11. Are you a resident of Bloomfield?

    1. Yes
    2. No
13. Proposed Recommendation to the Town Charter

    The Bloomfield Town Charter is available at: https://library.municode.com/ct/bloomfield/codes/code_of_ordinances?nodeId=CH

15. What section number of the Charter does your change affect?*
17. Proposed Recommendation *
19. Brief description of the issue addressed by the proposed change:*
21. Impact of Proposed Change
23. What benefits will be realized by the citizens and/or government of Bloomfield?*
25. What potential impacts may be associated with the proposal change?*
27. Can you provide data to assist in validating the impact of the proposed change?
29. Describe any obstacles, costs, or cost savings associated with the proposed change, if any?
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field