Traffic Complaint

I wish to file a complaint with the Essex Police Department concerning the improper operation of a motor vehicle.

Name*
Date of Birth*
MM slash DD slash YYYY
Phone (Home)
Phone (Work)
Email*
Address
Street Address Address Line 2 City State ZIP Code
Please provide the following information concerning the improper operation of the motor vehicle that you observed. Be as specific about the details of the incident as possible.
Vehicle Registration (State)*
Vehicle Registration (Plate Number)*
Vehicle Make, Model and Color*
Date of Incident*
MM slash DD slash YYYY
Time of Incident*

: Hours

Minutes

AM/PM
Location of the Incident (Street)*
Was this Reported to the Police? (Check One)*
- Yes
- No
Description of the Improper Operation
Consent
I agree that the information provided is the truth to the best of my knowledge. I acknowledge that filing a false police report is a crime and I will be prosecuted. The Essex Police Department Traffic Division is prepared to investigate this compliant. If a hearing is scheduled in this matter, you will be notified and required to attend. Do not submit this complaint to the Essex Police Department unless you are prepared to attend the hearing and give your testimony as to what occurred. This form in its entirety is available to the other party upon request.