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2. 
3. Bus Arm Violation Report
4. Bus Number
5. Date and Time Occurred
7. Drivers Full Name (First-Middle-Last)
8. Date of Birth
10. Home Address
12. City
13. State
14. Zip Code
16. Phone Number (for officer to call me)
17. Direction Violator
    -- Select One --NorthSouthEastWest
18. Direction of Bus
    -- Select One --NorthSouthEastWest
20. Students Outside Bus

    1. Yes
    2. No
21. # Students Outside
22. Weather

    1. Clear
    2. Rain/Snow
23. Road Conditions

    1. Dry
    2. Wet
    3. Icy
25. Location of Violation
27. Make and Model Suspect Vehicle
28. License Number - State
30. Description of Driver - Occupants
32. Describe In Detail the Incident
34. I certify all is true and correct.

    1. Yes
    2. No
35. I desire to pursue charges.

    1. Yes
    2. No
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field