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Incident Report
First Name
Last Name
*Email Address
*City of Incident
*State of Incident
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Intersection or Road
Where Incident Occurred
*GotellMom ID
(4-digit # on Bumper Sticker)
Type of Incident:
Speeding
Texting while driving
Not wearing seatbelt
Tailgating
Ran red light
Did not give proper right of way to drivers or pedestrians
On phone & not paying attention
Parked illegally (or parked inconsiderately)
Rolled stop sign
Did not signal lane change or turn
Improper use of car pool lane
Driving at night or in rain without headlights on
Tail light or necessary equipment is out
Hit & Run
Reckless driving
Parked at night in a public park or area
Too many passengers in car
Music too loud in neighborhood
Racing/street pollution
Other
Describe What Happened
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