|
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 |
