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2. 

   
   

4. First Name*
5. Last Name*
6. Date*
   Date
8. Email Address*
9. Phone Number*
11. Address*
13. City*
14. State*
15. Zip Code*
19. Area of Concern
21. Address for specified area of concern*
23. Jurisdiction*
    -- Select One --Spokane CountySpokane Valley
24. Reason*
    -- Select One --SpeedTraffic Volume
26. Speed Limit*
    -- Select One --253545
27. Direction of Traffic Issue*
    -- Select One --NorthSouthEastWest
29. School Zone?*

    1. Yes
    2. No
30. Is this location part of an HOA?*

    1. Yes
    2. No
32. Permission for trailer to be placed on your property?*

    1. Yes
    2. No
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field