INCIDENT
REPORT
These forms will
be used during the next legislative session to ensure appropriate lawmaking
and enforcement proceedings are achieved.
NAME:_________________________________________________ PHONE:
_______________________________
CITY:____________________________________________ STATE:_______________
ZIP:___________________
May we use your name for
legislative purpose? YES______ NO ______
DESCRIPTION OF
STOP:
Location:________________________________ Time:__________ Date:__________
Officer’s
Name:___________________________________ ID#: __________________
Agency (State,
County, City, etc):___________________________________________
Reason for
stop:__________________________________________________________
Citation
Issued? Yes_____ No _____
For:____________________________________________________________________
Did Officer
follow reasonable procedure? Yes _____ No______
Explain:_________________________________________________________________
Did Officer
Know the law? Yes___ No___ Was Officer courteous? Yes___ No ___
Outcome of
stop:_________________________________________________________
Thank You For Your Assistance