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Report State Vehicle Abuse

 

 

To file a complaint regarding a state vehicle, please complete the following form.
This information will be forwarded to the proper state agency for further investigation.
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Vehicle Information

 
 
1.   Number of occupants (Select one)
 
 
2.   License Plate Number    (Type Answer)
 
(7 character limit; 7 remaining.)
 
3.   Vehicle color    (Type Answer)
 
(15 character limit; 15 remaining.)
 
4.   Department name (Located under the State Seal on the doors)    (Type Answer)
 
(30 character limit; 30 remaining.)
 
5.   Vehicle Description (provide make & model if possible)    (Type Answer)
 
(100 character limit; 100 remaining.)
 

Driver Information

 
 
6.   Driver's gender    (Select one)
  Male    Female    Unknown   
 
7.   Was the driver wearing a seatbelt?    (Select one)
  Yes    No    Unknown   
 

Incident Information

 
 
8.   Date of the incident (Example: MM/DD/YYYY)
 
 
9.   Time of the incident (PLEASE USE THIS FORMAT 2:14 PM)    (Type Answer)
 
(10 character limit; 10 remaining.)
 
10.   Location of the incident (Provide Route and/or Street name & number and City/Town)    (Type Answer)
 
(200 character limit; 200 remaining.)
 
11.   Description of the incident    (Type Answer)
 
(500 character limit; 500 remaining.)
 

Complainant Information

 

 

You may elect to leave the following fields blank and submit this form anonymously.

However, in doing so, we will not be able to contact you if we require further information about the incident in order to complete our investigation.

 
12.   Name    (Type Answer)
 
(50 character limit; 50 remaining.)
 
13.   Address
 
Address Line 1:
Address Line 2:
City / State / Zip:

14.   Phone number (Example: 999-111-0000)
 
 
15.   E-mail address    (Type Answer)
 
(30 character limit; 30 remaining.)
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