Violation Report
Date Violation Occurred  
<June 2017>
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28293031123
45678910
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2526272829301
2345678
Time Violation Occurred
(HH:MM) Military Time
 
Premises Category   
Violation Type  
Premises Name  
Street Address  
City  
State Washington
Phone  
Please describe the alleged violation

 
Contact information
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Name
Title
Address
Telephone
FAX
E-mail

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