Traffic Incident Complaint

Last Name:_________________ First Name:____________________________

Address:________________________City:____________Zip:__________________

Home Phone:_____________Work Phone:_________Cell Phone:_______________

Type of Complaint: Speeding Vehicles Racing Loud Noise Curfew Animal Other

Location:____________________________ Subdivision_____________________________

Time(s): ____________________________ Days of week/weekend:________________________

Additional Information:_______________________________________________________________

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SIGNATURE DATE

Action Taken:_______________________________________________________________________

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DEPUTY (s) __________________ DATE _________________

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