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2. Reporting Party's Name
3. Reporting Party's Phone #
4. Reporting Party's Email
8. Information of The Vehicle You Observed Driving Recklessly
10. Make*
11. Model*
12. Approximate Year*
14. License Plate*
15. State of License Plate*
19. Describe The Reckless Driving Activity You Observed*
21. Provide The Location of Your Observation*
23. Provide The Date & Time of Your Observation*
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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