Required fields are marked with asterisks (*)

Traffic Concern Form - Police Department

Please provide information below about any traffic incidents you observed.

1. Date of the incident.

2. Location of the incident.

3. Description of traffic concern.

4. Do you know the license plate number of the vehicle that was causing the problem?

Yes

5. If yes, then please provide the license plate number. If no, then please give a description of the vehicle.

6. Name (Optional, but allows us to contact you for follow up)

7. Phone Number (Optional, but allows us to contact you for follow up)

8. Email Address (Optional, but allows us to contact you for follow up)