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2. Jacksonville, Arkansas
   City of Jacksonville, Arksansas
4. Intersection of Traffic Signal
5. Approximate Time of Day
   Approximate Time of Day
7. Address of Light Outage / Damage
9. Nature of Signal Problem
   -- Select One --Signal OutSignal Changes too SlowlySignal Changes too QuicklyOther
10. If other:
12. Direction of Travel
13. Email
15. Zip Code*
16. Other than Jacksonville, Arkansas
    If other than Arkansas, Jacksonville please notify proper organization.
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18. 1. Receive an email copy of this form.
19. Email address

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20. Submit

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