Witness Name: Provide your first and last name Witness Address Provide your full address including post office box number Witness Phone Number Witness E-mail Address Date of Incident Year Year20192020202120222023 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Time of the Incident Hour hour123456789101112: Minute minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Who or What was Involved Name of the person(s) involved or licence plate and description of the vehicle Location or Address of the Event Incident Details What did you see, hear, smell, etc. and how did it affect you? For example, If your report is regarding noise, record how often the infraction occurred ( use multiple copies of the Witness Report form for each occurrence, or create a noise evidence log to record each date, start and stop time, noise description (eg: shrill, repetitive, thumping, penetrating, whooping, singing, amplified music, heard indoors, etc.) and how it affected you (eg: woke you up, gave you a headache, kids couldn’t get to sleep, etc.) Your Actions and Other Witnesses Describe in detail what actions, if any, you took to resolve the matter or incident. Document any additional persons or witnesses that may corroborate the evidence you've provided. Email Evidence to reception@lionsbay.ca Video Evidence Photographic Evidence Audio Evidence Other Evidence To indicate if evidence has been sent to reception@lionsbay.ca please check the type of file you've sent.