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Name / Nombre
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First / El nombre primero
Last / Apellido
Address / Dirección
Street Address/Dirección
Address Line 2/Dirección Segunda
City/Ciudad
State/Province/Region [Estado/Provincia/Región]
Postal / Zip Code[Código postal]
Country / Region [país / región]
Email / el e-mail
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Date of Incident / Fecha del incidente
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Route Number / Numero de ruta
Bus Number / Número de autobús
Direction of Travel / Dirección de viaje
Describe the Incident / Describe el incidente
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Desired outcome / Resultado deseado
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