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2. First Name*
3. Last Name*
4. Phone Number*
6. Address1
8. Address2
10. City
11. State
12. Zip
14. Please Describe the Traffic Complaint*
16. Is there a specific time you notice the issue?
18. If a specific person/vehicle is the reason for your complaint, enter a description here
20. Would you like an officer to contact you?*

    1. Yes
    2. No
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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