Traffic Complaint Form

2. Type of Traffic Problem*

   The following items marked with an asterisk (*) are required for theLake Stevens Police to properly investigate your report.
   

   1. Handicapped Parking
   2. Parking
   3. Reckless Driving
   4. Red Light Running

   1. Speeding
   2. Stop Sign
   3. *Other
4. Other

   Please let us know what occurred.

6. Location of Complaint

   Example: 200 Block of Forest Ave. or Forest Ave. and Middlefield Rd., etc.

8. Date of Incident
   Date of Incident

9. Time of Incident
   Time of Incident

11. Additional Time Information

    Example: Occurring every morning 8:00 am to 9:00 am or Saturday and Sunday only, etc

13. Year, Make and Model

    Please tell us the Vehicle Year, Make, Model, License Number, Color of vehicle and Vehicle description.

15. Remarks or Comments:

    Other Remarks or Comments You May Have?

17. Response Requested?

    1. Yes

    If you would like a return response about your complaint, please provide the information below and we will contact you as soon as possible. Thank you for helping us to better serve you.

21. First Name

22. Last Name

24. Address1

26. Address2

28. City

29. State

30. Zip

32. Phone Number

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field