Optional Information

Name (optional):

Address (optional):

Phone (optional):

E-Mail (optional):

Required information

Choose one option: [reference RCW 42.17.310(1)(e) ]

Please withhold my name on any publicly disclosed documents that result from this complaint.

You may reveal my name on any publicly disclosed documents that result from this complaint.

Location of Concern:
(include direction traveled, name of the state route, interstate or city/county road, as well as any cross street, or milepost)

Description of vehicles seen:
(make, model, and license plate numbers of each, if possible)

Brief description of activities observed:

Number of times observed:
(days, weeks, months, years)