Virginia Reckless Driving Preliminary Case Analysis Form

First name:
Last name:
State of residence:
County/City of residence:
Preferred phone number:
Best time to call:
Email address:
State of operator's license:
County of offense:
Location of offense:
Date of offense:
Make of car:
Year of car:
Select type of reckless offense:
	By Speed	Posted speed limit:	Speed cited:
	General Provision	Was there an accident involved?
	General Provision	yes no
	Other	Name of offense:
How did the officer determine your speed? (select all that apply)		Radar Lidar Pace Don't Know
Were there any passengers in the car?		yes no
Do you have any prior moving violations?		yes no
Do you have a pending court date?
yes	no	If yes, provide date:
Did you make any statements to the officer?		yes no
Brief description of events: