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TRAFFIC COMPLAINT AND REQUEST FOR COURTESY NOTICE Date of Occurrence: Time of Occurrence: Location of Occurrence: Type of Violation: Speeding (Please estimate speed) Failure to stop at Stop Sign Other, please specify: Responsible vehicle: License Driver Person reporting: Name: Address: Phone number: Please mail this completed form to: Traffic Unit Modesto Police Department 600 10th Street Modesto, CA 95354 IF YOU OBSERVE A VEHICLE THAT YOU SUSPECT IS BEING OPERATED BY A DRIVER WHO YOU BELIEVE IS UNDER THE INFLUENCE OF ALCOHOL OR DRUGS, CALL 9-1-1 AND REPORT THIS IMMEDIATELY. CITY OF MODESTO POLICE DEPARTMENT