LOUISIANA STATE DEPARTMENT OF EDUCATION

LOUISIANA STATE DEPARTMENT OF EDUCATION

(Re: L.R.S. 32:80)

Illegal Passing Violation Reporting Form for Act 60, Regular Session 2007

Directions: Please print and complete sections 1-5 in black ink. Use back of form for narrative, names of additional witnesses and/or diagrams. The school bus driver's signature must be authenticated by two witnesses, who must sign this form, as required by law. After securing the local transportation supervisor's signature, this reporting form should be submitted to the local law enforcement agency which has jurisdiction in the area where the violation occurred.

1. Violation occurred on _______________________ at___________ a.m./p.m. in

(mm/dd/yy)

(time)

______________________________________(Parish/City).

The violation occurred on the following highway, roadway, street:_________________

_____________________________ School bus direction: E W N S

2. School District____________________________________________________________

3. School Bus Driver_________________________________________________________

4. Violating Vehicle

Make/Model____________________________________________________________

Other Distinguishable Attributes____________________________________________

License Plate

State_________________________

Number____________________________

Violating Vehicle Direction: E W N S

Driver (offer as much information as possible)

Gender: Male _____ Female_____ Race: White_____ Black_____ Other_____

(check one)

(check one)

5. School Bus Driver's Signature______________________________________________

6. Address:_______________________________________________________________

(street)

(city)

(state)

(zip)

Phone_________________________________________________________________

Witness 1 Signature:_____________________________________________________

Witness 2 Signature:_____________________________________________________

7. Transportation Supervisor Signature:_______________________________________

FOR LAW ENFORCEMENT AGENCY ONLY

____________________________ Date:_________________Hour:_________a.m./p.m.

(Name of Law Enforcement Agency)

(Circle One)

Received by:________________________ Referred/Assigned to:_________________

License Plate Number assigned to: Name_____________________________________

Street Address___________________________________________________________

City/State/Zip___________________________________________________________

Citation Issuance Date:_____________________ Court Date:__________________

School Bus Driver contacted/served for court date: Yes___ No___ Date Notified____

In making this report, the school bus driver is acting as duly authorized agent of the school system shown above. By signing this form, the school bus driver is stating that to his/her best knowledge, the information above is true and accurate. The form may be sent by mail, fax, or electronically. If mailed, the notice shall be deemed timely if post-marked the day after the violation.

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