Spring Shadows Civic Association
Patrol & Safety Committee
Suggestion/Concern Form

Your Patrol/Safety Concern:____________________________________________

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What can you tell us about the cause?_____________________________________

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Do you have a recommendation for the Patrol/Safety committee?

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Date:________________ Name:_________________________________________

Phone:_______________ Address:_______________________________________

Would you desire your name kept confidential on this matter if we can?

YES_________ Doesn't matter __________ Other __________________________

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Space Below for Committee Use Only

Acknowledged date:_______________ Initial Steps: ________________________

Priorities:__________________________________________________________

Law/Govt?:_________________________________________________________

Committee Findings:__________________________________________________

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Date_________________ _____________________________________________