Binghamton Traffic Board
City Hall, Government Plaza
38 Hawley Street, 4
th
Floor
Binghamton, NY 13901
http://www.binghamton-ny.gov
DIRECTIONS: Please print or type. Please answer all questions completely.
NAME: ____________________________________________________________________________________________
ADDRESS: _________________________________________________________________________________________
(Number) (Street) (City)
EMAIL ADDRESS: ____________________________________________________________________________________
TELEPHONE: __________________________________ DATE: ________/________/________
LOCATION OF TRAFFIC BOARD REQUEST (street address or intersection):
__________________________________________________________________________________________________
DESCRIBE THE REQUEST (be as specific as possible, use additional pages if necessary):
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
For Internal Use Only
Approved: Denied:
Referred to: __________________________