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2. Date and Time submitted
   Date and Time submitted

   Date and Time submitted
3. Location of violation*
5. Day of Week violation occurs
   -- Select One --SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAYALL/OR NO PARTICULAR DAY

   Please indicate which day of the week this is occuring
6. Usual time of occurrence
   Usual time of occurrence
   Indicate time of day occuring
7. Type of Offense*
   -- Select One --SpeedingSchool Zone ViolationStop Sign ViolationCrosswalk Pedestrian ViolationParking ProblemOther sign violationsOther

   Choose type of offense
9. Type of Offense explained
   Please explain violation if needed
11. Submitter Name*
12. Email Address
14. Address
16. Phone Number
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field