Attention: Langley Grove Estates Management 

A resident has reported an incident of speeding and/or dangerous driving.

Date: 

Time: 

Address: 24330 Fraser Highway Langley BC

Location of offense: 

Direction of travel: 

Description of vehicle: 

License Plate Number: 

Resident: (Yes/No) 

Resident Lot #: 

Lot # Verified: (Yes/No) 

Is this the first offense for this vehicle?: (Yes/No) 

Frequency of Offense: (eg: daily) 


Comments:









Report Verified: (Yes/No) 

Follow up required: (Yes/No) 


Signed:

Your Name 

Your Lot# 

Your Phone# 

Your Email Address