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2. Road Request Form

   This form is for Precinct 1 - Terry Crow - You must contact other precincts by phone or email  

   NOTE: Kaufman County Precinct 1 Maintenance is only responsible for County Roads (CR) within the boundaries of Precinct 1 and not Farm To Market (FM) or State Highways. 

4. Disclaimer:

   Kaufman County is only responsible for County Roads. Any road work requests on FM Roads and State or US Highways need to be reported to TxDOT at 972-962-3848. Any repairs on city streets need to be reported to those respective cities. 

6. Date
   Date
8. County Road Name/Number*

   Please provide the name/number of the County Road and the location of the needed repair, i.e. 100 feet from the intersection @ CR 123 in the westbound lane.  Be specific please. 

10. Road Work Being Requested*

    Please be as specific about the road condition as possible. i.e. large pothole in the westbound lane as you approach CR 155. Also large tree branches laying across the roadway. 

12. Full Name

    Optional

13. Email Address

    Optional

15. Phone Number

    Optional

16. Cell Number

    Optional

18. Upload an image

    Please upload an image of the road damage if possible.

20. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print