Box |
Description |
1
|
District Court Number
|
| 2 |
Docket Number |
| 3 |
District Court Address |
| 4 |
Defendant's Driver's License #
(moving violations only) |
| 5 |
CDL – Yes or No
(moving violations only) |
| 6 |
State Issuing Driver's License
(moving violations only) |
| 7 |
Defendant's Date of Birth
(moving violations only) |
| 8 |
Sex of Defendant
(moving violations only) |
| 9 |
Defendant's Name |
| 10 |
Defendant's Address |
| 11 |
License Plate Number |
| 12 |
Date of Last Registration |
| 13 |
State of Vehicle Registration |
| 14 |
Make of Vehicle |
| 15 |
Type of Vehicle |
| 16 |
Color of Vehicle |
17-
22
|
Repeat 11-16
(rarely used)
|
| 23 |
Owner/Lessee's Name & Address
(moving violations only) |
| 24 |
Charge |
| 25 |
Specifics of Charge |
| 26 |
Indicates Statute or Ordinance |
| 27 |
Section Charged |
| 28 |
Subsection Charged |
| 29 |
Amount of Fine |
| 30 |
Emergency Medical Services Fund
(added State cost) |
| 31 |
Catastrophic Fund
(added State cost)
No CAT Fund charge for motorcycle violations
|
| 32 |
Court Costs
(added State cost) |
| 33 |
Judicial Computer Project/
Access to Justice Court
(added State cost)
|
| 34 |
Total Fines & Costs Due |
| 35 |
Location of Offense |
| 36 |
Zone of Offense |
| 37 |
Route of Offense |
| 38 |
Municipality of Offense |
| 39 |
Code |
| 40 |
Direction Vehicle Traveling |
| 41 |
Date of Offense |
| 42 |
Time of Offense |
| 43 |
Day of Offense |
| 44 |
County of Offense |
| 45 |
Code |
| 46 |
Defendant's Signature
(signature not required for citation to be valid) |
| 47 |
Date Citation Issued |
| 48 |
Officer's Signature & Badge # |
| 49 |
Police Station Address |
| 50-57 |
Details for Speeding Violations
(speeding violation only) |
| 58 |
Accident Report Number
(in case of accident only) |
| 59 |
Parents Notified – Yes or No
(juvenile defendant only) |
| 60 |
Commercial Vehicle – Yes or No |
| 61 |
Hazardous Materials – Yes or No |
| 62 |
Officer's Remarks and/or
Subpoena Lists |
