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Illegal Auto Lighting

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*Defendant:
(who caused the harm?)

*Describe your complaint:
(briefly describe the damages you have suffered)

Were you involved in a collision?

Yes No

Do you feel that excessively bright oncoming lights contributed to the accident?

Yes No

Was the other driver given a ticket?

Yes No

Did the ticket mention HID or illegal lights?

Yes No

Were you given a citation or ticket in the incident?

Yes No

If yes, what was the specific violation or violations you were cited for

*First name:

*Last name:

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