DUE: December 13, 2004	MOBILIZATION ACTIVITY REPORT					FOR GHSB USE ONLY:
MAIL TO: Caroline Hymoff, Senior Program Manager	November 15 - 28, 2004					PSP:_________ Task:_______
Governor's Highway Safety Bureau	Click It Or Ticket					Date:____________________________
One Ashburton Place - Room 611						GHSB Signature:_______________________
Boston, MA 02108	City/Town Reporting:____________________________________________
617-727-4054 extension 25558	**Original Plus One Copy**
						Total Speeding		Other (please specify)
Officer's Last Name	Date	Total Number Stops	Total Safety Belt Citations	Total Child Passenger Safety Citations	Total Number DUI Arrests	Citations	Written Warnings	Citations	Written Warnings
GRAND TOTALS---------------------------------------->
(must be completed)
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