Traffic Calming Petition Form - City of Fort Wayne

PETITION FOR TRAFFIC CALMING
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Date Received by the Traffic Engineering Department: _________________
We, the undersigned residents of the City of Fort Wayne, do hereby petition the Board of Public Works (and the
Board of Public Safety where applicable) of the City of Fort Wayne, to make the following change(s) in traffic
control (Please describe the location, specific signage, signalization, change in speed limits, etc., which are
being requested):
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By signing this petition, the signatory affirms that she/he is authorized to do so and thereby bind the owner(s) of the
respective parcel to the effect of this petition
Petition Contact Person – Name: _____________________________________________________
Address (include ZIP): _____________________________________________________
Home Phone: ____________________ Work Phone: ___________________________
Signatures – (This petition must be signed by at least 75% of affected residents on both sides of the entire
block(s) affected and returned to Traffic Engineering. The Board of Works (and the Board of Public Safety
where applicable) approves projects upon the recommendation of the Traffic Engineering Department. The
necessary signs are installed at 100% cost to the City, when funds become available.)
Signature Printed Name Street Address & Zip
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PETITION FOR TRAFFIC CALMING (CONTINUED)
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Signature Printed Name Street Address & Zip
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