OFFICIAL RESIDENT SPEED HUMP CONCURRENCE FORM

OFFICIAL RESIDENT SPEED HUMP CONCURRENCE FORM
Date of Issue (Day "1"): 10/17/2025 Completed forms must be returned to Montgomery County DTEO by the Community Contact Person no later than: 5:00 p.m. 01/19/2026

Location: Needwood Road-between- Redland Road and Quincewood Court

Plan Description: Install eight (8) "flat top" speed humps and associated warning signs
NOTICE TO RESIDENT
Prior to indicating support or opposition, please read the Speed Hump Fact Sheet and review the Speed Hump Location Plan.

(Both must be presented with this Form)

Speed Hump Speed Hump Location Plan Fact Sheet
Signature*
Print Full Name*

First NameLast Name
Date*

MonthDayYear
Date
ADDRESS*
I READ the Speed Hump Fact Sheet*
Type "X" to confirm
I REVIEWED the Speed Hump Location Plan*
Type "X" to confirm
I SUPPORT the Plan
I OPPOSE the Plan
TO THE CIRCULATOR OF THIS FORM

Upon resident's completion of the appropriate entries, please record your name and the date here: All occupied households slated for polling must be notified of the Speed Hump Location Plan. Occupied households with no response will be counted as opposing the plan. Please record the dates that you attempted to poll the residence. Please indicate any residences that are vacant on the date that the completed Concurrence Forms are returned to the Division of Traffic Engineering and Operations (DTEO) of the Montgomery County Department of Transportation. Completed Concurrence Forms must be returned to DTEO by the Community Contact Person (or approved designee) by the date specified above. Resident may keep the Speed Hump Fact Sheet and Speed Hump Location Plan after completing this form. However, please maintain possession of all Concurrence Forms that are assigned to you for circulation until you return them to the Community Contact Person.
name of circulator
date

MonthDayYear
Date
Should be Empty:

OFFICIAL RESIDENT SPEED HUMP CONCURRENCE FORM

NOTICE TO RESIDENT