Name________________________________________________________
Phone_________________
City____________________________________________ State_____________
Zip____________
MAY WE USE YOUR NAME FOR LEGISLATIVE PURPOSES? 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(Explain)
________________________________________________________________________
________________________________________________________________________
Did Officer know the
law__________________________________________________________________
Was officer courteous yes______ no_______
Outcome of stop
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Use back if needed for more detail, unless you fax this then use 2 pages
Thank you for your assistance.
MAIL TO:or FAX TO
TMRA2,
Cell number is 512-971-6777
office #512-281-0537
or 817-685-8693