Fill and Sign the Sc Judicial Branch Form

Court's Original Copy - White 1-9 MPH 10-14 MPH 15-19 MPH 20-24 MPH 25-29 MPH 30-34 MPH PENALTY SCHEDULE ON REVERSE 1 No. CODE TRAFFIC OFFENSES - (check one) - TITLE 39: Unit Code Telephone 4-98 Speeding MPH in a YOU ARE HEREBY SUMMONED TO APPEAR BEFORE THIS COURT TO ANSWER THIS COMPLAINT CHARGING YOU WITH THE OFFENSE LISTED: Driver's License Number EXP. DATE S TAT E  Commercial License THE UNDERSIGNED CERTIFIES THAT Name First Initial Last (Please Print) Address City State Zip Code Birth Date Eyes Sex Weight Height Restrictions C O DE C O DE C O DE DID UNLAWFULLY (PARK) (OPERATE) A Make Of Vehicle Year Body Type Color Lic. Plate No. State Exp. Date  Commercial Vehicle  Hazardous Material Offense Date Month Day Year Time : AM Hour : PM LOCATION OF OFFENSE Describe Location Municipality County Mun. Code (Offense) AND DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE (ONE CHARGE PER COMPLAINT) 3-4 Unregistered vehicle 3-29 Failure to exhibit documents D.L. or REG or INS 3-33 Unclear plates 3-66 Maintenance of lamps 3-76.2f Failure to wear seatbelt 4-81 Failure to observe signal 4-85 Improper passing 4-97 Careless driving 4-12 4Failure to turn 4-144Failure to stop or yield 8-1 Failure to inspect 8-4 Failure to make repairs MPH zone PARKING OFFENSE  Overtime Meter No.  Prohibited Area  Double OTHER TRAFFIC/PARKING OFFENSE (Describe) Statute No. Ordinance / Code No. THE UNDERSIGNED FURTHER STATES THAT THERE ARE JUST AND REASONABLE GROUNDS TO BELIEVE THAT YOU COMMITTED THE ABOVE OFFENSE AND WILL FILE THIS COMPLAINT IN THIS COURT CHARGING YOU WITH THAT OFFENSE. Month Day Year Signature of Complaining Witness Officer's ID. No. NOTICE TO APPEAR  COURT DATE Month Day Year Time : AM Hour : PM  Truck  Accident  Personal Injury  Property DamageAREA ROAD TRAFFIC VISIBILITY  Business Dry Light Clear  School Wet Medium Rain  Residential Snow Heavy Snow  Rural Ice  Fog CONDITIONS Equipment  Helicopter  Pace  VASCAR  Radar  Breathalyzer Equipment Operator's Name Operator ID No. CPO 171C (12/99) IN EXCESS OF SPEED LIMIT BY: COURT APPEARANCE REQUIRED 65 MPH Zone Construction Zone 2 3456 13 789101112 XXXXX XXXXXX MIAMI SYSTEMS CORP., CLIFTON, NJ 973-773-8800 Court's Original Copy - Back BENCH WARRANT BAIL INFORMATION Warrant Date // Court's Copy Ordered by: (Signature and title of person setting bail) Bail Amount $ Set by: (Signature and title of person issuing warrant) FIRST APPEARANCE, ARRAIGNMENT AND COUNSEL INFORMATION MISCELLANEOUS INFORMATION EVENT COURT ACTION First Appearance Date: // Arraignment Date: // Advised of Rights: By: DefendantDesires Counsel: Yes No Counsel assigned: Y (If yes, name of counsel) N Counsel retained: Counsel waived:Y Y (If yes, name of counsel) (If yes, name of Judge accepting waiver) N N Name of Prosecuting Attorney: Affiliation: Municipal County State Other (list) Additional Information and Judge's Notes: Adjournment Requested by Reason To // // See attached sheet for additional Judge's notes or other information. Plea and Date: G NG Finding or Dismissal; Date: G NG DISMISSED Fine $ VCCB $ Other $ // // Other $ Total $ Period of D.L. Suspension: Jail Term / Jail Credit: Credit for Signature of Judge: Date: // Failed to Appear Date //
Forfeited
Return
Reinstated //(Date) (Signature of Judge) Complaint Amended To: IDRC: Comm. Serv.: DW I $ Costs $ SNSF $ Contempt $ Police Copy - Blue 1-9 MPH 10-14 MPH 15-19 MPH 20-24 MPH 25-29 MPH 30-34 MPH PENALTY SCHEDULE ON REVERSE 1 No. CODE TRAFFIC OFFENSES - (check one) - TITLE 39: Unit Code Telephone 4-98 Speeding MPH in a YOU ARE HEREBY SUMMONED TO APPEAR BEFORE THIS COURT TO ANSWER THIS COMPLAINT CHARGING YOU WITH THE OFFENSE LISTED: Driver's License Number EXP. DATE S TAT E  Commercial License THE UNDERSIGNED CERTIFIES THAT Name First Initial Last (Please Print) Address City State Zip Code Birth Date Eyes Sex Weight Height Restrictions C O DE C O DE C O DE DID UNLAWFULLY (PARK) (OPERATE) A Make Of Vehicle Year Body Type Color Lic. Plate No. State Exp. Date  Commercial Vehicle  Hazardous Material Offense Date Month Day Year Time : AM Hour : PM LOCATION OF OFFENSE Describe Location Municipality County Mun. Code (Offense) AND DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE (ONE CHARGE PER COMPLAINT) 3-4 Unregistered vehicle 3-29 Failure to exhibit documents D.L. or REG or INS 3-33 Unclear plates 3-66 Maintenance of lamps 3-76.2f Failure to wear seatbelt 4-81 Failure to observe signal 4-85 Improper passing 4-97 Careless driving 4-12 4Failure to turn 4-144Failure to stop or yield 8-1 Failure to inspect 8-4 Failure to make repairs MPH zone PARKING OFFENSE  Overtime Meter No.  Prohibited Area  Double OTHER TRAFFIC/PARKING OFFENSE (Describe) Statute No. Ordinance / Code No. THE UNDERSIGNED FURTHER STATES THAT THERE ARE JUST AND REASONABLE GROUNDS TO BELIEVE THAT YOU COMMITTED THE ABOVE OFFENSE AND WILL FILE THIS COMPLAINT IN THIS COURT CHARGING YOU WITH THAT OFFENSE. Month Day Year Signature of Complaining Witness Officer's ID. No. NOTICE TO APPEAR  COURT DATE Month Day Year Time : AM Hour : PM  Truck  Accident  Personal Injury  Property DamageAREA ROAD TRAFFIC VISIBILITY  Business Dry Light Clear  School Wet Medium Rain  Residential Snow Heavy Snow  Rural Ice  Fog CONDITIONS Equipment  Helicopter  Pace  VASCAR  Radar  Breathalyzer Equipment Operator's Name Operator ID No. CPO 171C (12/99) IN EXCESS OF SPEED LIMIT BY: COURT APPEARANCE REQUIRED 65 MPH Zone Construction Zone 2 3456 13 789101112 XXXXX XXXXXX MIAMI SYSTEMS CORP., CLIFTON, NJ 973-773-8800 Police Copy - Blue - Back DISPOSITION OF CASE FROM: // TO: // REASON: FROM: // TO: // REASON: DISPOSITION DATE: DATES OF ADJOURNMENTS:BY: COURT VIOLATIONS BUREAU PLEA: FINDING: BAIL INFORMATION SENTENCE OFFICER'S COMMENTS WITNESSES: (NAME & ADDRESS) SUBPOENA ISSUED BAIL AMOUNT $ CASH BOND POSTED WITH: (NAME & TITLE) BAIL FORFEITURE: AMOUNT $ DATE // FINE $ COSTS $ $ $ $ $ JAIL: DAYS: DR. LIC. REVOKED: DAYS REVOCATION DATE: // (See Instructions On Cover) 1. 2. 3. YES NO Officer's Copy - Yellow 1-9 MPH 10-14 MPH 15-19 MPH 20-24 MPH 25-29 MPH 30-34 MPH PENALTY SCHEDULE ON REVERSE 1 No. CODE TRAFFIC OFFENSES - (check one) - TITLE 39: Unit Code Telephone 4-98 Speeding MPH in a YOU ARE HEREBY SUMMONED TO APPEAR BEFORE THIS COURT TO ANSWER THIS COMPLAINT CHARGING YOU WITH THE OFFENSE LISTED: Driver's License Number EXP. DATE S TAT E  Commercial License THE UNDERSIGNED CERTIFIES THAT Name First Initial Last (Please Print) Address City State Zip Code Birth Date Eyes Sex Weight Height Restrictions C O DE C O DE C O DE DID UNLAWFULLY (PARK) (OPERATE) A Make Of Vehicle Year Body Type Color Lic. Plate No. State Exp. Date  Commercial Vehicle  Hazardous Material Offense Date Month Day Year Time : AM Hour : PM LOCATION OF OFFENSE Describe Location Municipality County Mun. Code (Offense) AND DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE (ONE CHARGE PER COMPLAINT) 3-4 Unregistered vehicle 3-29 Failure to exhibit documents D.L. or REG or INS 3-33 Unclear plates 3-66 Maintenance of lamps 3-76.2f Failure to wear seatbelt 4-81 Failure to observe signal 4-85 Improper passing 4-97 Careless driving 4-12 4Failure to turn 4-144Failure to stop or yield 8-1 Failure to inspect 8-4 Failure to make repairs MPH zone PARKING OFFENSE  Overtime Meter No.  Prohibited Area  Double OTHER TRAFFIC/PARKING OFFENSE (Describe) Statute No. Ordinance / Code No. THE UNDERSIGNED FURTHER STATES THAT THERE ARE JUST AND REASONABLE GROUNDS TO BELIEVE THAT YOU COMMITTED THE ABOVE OFFENSE AND WILL FILE THIS COMPLAINT IN THIS COURT CHARGING YOU WITH THAT OFFENSE. Month Day Year Signature of Complaining Witness Officer's ID. No. NOTICE TO APPEAR  COURT DATE Month Day Year Time : AM Hour : PM  Truck  Accident  Personal Injury  Property DamageAREA ROAD TRAFFIC VISIBILITY  Business Dry Light Clear  School Wet Medium Rain  Residential Snow Heavy Snow  Rural Ice  Fog CONDITIONS Equipment  Helicopter  Pace  VASCAR  Radar  Breathalyzer Equipment Operator's Name Operator ID No. CPO 171C (12/99) IN EXCESS OF SPEED LIMIT BY: COURT APPEARANCE REQUIRED 65 MPH Zone Construction Zone 2 3456 13 789101112 XXXXX XXXXXX MIAMI SYSTEMS CORP., CLIFTON, NJ 973-773-8800 Officer's Copy - Yellow - Back DISPOSITION OF CASE FROM: // TO: // REASON: FROM: // TO: // REASON: DISPOSITION DATE: DATES OF ADJOURNMENTS:BY: COURT VIOLATIONS BUREAU PLEA: FINDING: BAIL INFORMATION SENTENCE OFFICER'S COMMENTS WITNESSES: (NAME & ADDRESS) SUBPOENA ISSUED BAIL AMOUNT $ CASH BOND POSTED WITH: (NAME & TITLE) BAIL FORFEITURE: AMOUNT $ DATE // FINE $ COSTS $ $ $ $ $ JAIL: DAYS: DR. LIC. REVOKED: DAYS REVOCATION DATE: // (See Instructions On Cover) 1. 2. 3. YES NO Defendant's Copy (Hard Copy) - Buff 1-9 MPH 10-14 MPH 15-19 MPH 20-24 MPH 25-29 MPH 30-34 MPH PENALTY SCHEDULE ON REVERSE 1 No. CODE TRAFFIC OFFENSES - (check one) - TITLE 39: Unit Code Telephone 4-98 Speeding MPH in a YOU ARE HEREBY SUMMONED TO APPEAR BEFORE THIS COURT TO ANSWER THIS COMPLAINT CHARGING YOU WITH THE OFFENSE LISTED: Driver's License Number EXP. DATE S TAT E  Commercial License THE UNDERSIGNED CERTIFIES THAT Name First Initial Last (Please Print) Address City State Zip Code Birth Date Eyes Sex Weight Height Restrictions C O DE C O DE C O DE DID UNLAWFULLY (PARK) (OPERATE) A Make Of Vehicle Year Body Type Color Lic. Plate No. State Exp. Date  Commercial Vehicle  Hazardous Material Offense Date Month Day Year Time : AM Hour : PM LOCATION OF OFFENSE Describe Location Municipality County Mun. Code (Offense) AND DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE (ONE CHARGE PER COMPLAINT) 3-4 Unregistered vehicle 3-29 Failure to exhibit documents D.L. or REG or INS 3-33 Unclear plates 3-66 Maintenance of lamps 3-76.2f Failure to wear seatbelt 4-81 Failure to observe signal 4-85 Improper passing 4-97 Careless driving 4-12 4Failure to turn 4-144Failure to stop or yield 8-1 Failure to inspect 8-4 Failure to make repairs MPH zone PARKING OFFENSE  Overtime Meter No.  Prohibited Area  Double OTHER TRAFFIC/PARKING OFFENSE (Describe) Statute No. Ordinance / Code No. THE UNDERSIGNED FURTHER STATES THAT THERE ARE JUST AND REASONABLE GROUNDS TO BELIEVE THAT YOU COMMITTED THE ABOVE OFFENSE AND WILL FILE THIS COMPLAINT IN THIS COURT CHARGING YOU WITH THAT OFFENSE. Month Day Year Signature of Complaining Witness Officer's ID. No. NOTICE TO APPEAR  COURT DATE Month Day Year Time : AM Hour : PM  Truck  Accident  Personal Injury  Property DamageAREA ROAD TRAFFIC VISIBILITY  Business Dry Light Clear  School Wet Medium Rain  Residential Snow Heavy Snow  Rural Ice  Fog CONDITIONS Equipment  Helicopter  Pace  VASCAR  Radar  Breathalyzer Equipment Operator's Name Operator ID No. CPO 171C (12/99) IN EXCESS OF SPEED LIMIT BY: COURT APPEARANCE REQUIRED 65 MPH Zone Construction Zone 2 3456 13 789101112 XXXXX XXXXXX MIAMI SYSTEMS CORP., CLIFTON, NJ 973-773-8800 Defendant's Copy (Hard Copy) - Back - Buff If you intend to plead not guilty to the offense charged in this Complaint and Summons and have a trial, you must notify the Court Administrator, whose address and telephone number are shown below, of your intention at least 7 days prior to your scheduled court date. If you fail to notify the Court Administrator, it may be necessary for you to make 2 court appearances. IF YOU FAIL TO APPEAR IN RESPONSE TO THIS SUMMONS OR TO PAY THE PRESCRIBED PENALTY, ADDITIONAL PENALTIES MAY RESULT, A WARRANT MAY BE ISSUED FOR YOUR ARREST AND YOUR DRIVING PRIVILEGES IN NEW JERSEY MAY BE REVOKED. IF YOU HAVE BEEN CHARGED WITH A PARKING OFFENSE, YOUR FAILURE TO APPEAR OR PAY THE PRESCRIBED PENALTY SHALL BE CONSIDERED AN ADMISSION OF LIABILITY AND A DEFAULT JUDGMENT MAY BE ENTERED AGAINST THE OWNER OF THE VEHICLE. Title 39: 3-4 3-29 3-33 3-66 3-76.2f 4-81 4-85 4-97Offense Unregistered vehicle Failure to exhibit docs. Unclear Plates Maintenance of lamps Failure to wear seatbelt Failure to observe signal Improper passing Careless driving Title 39: Offense Penalty Penalty $44.00 $44.00 $44.00 $44.00 $42.00 $78.00 $78.00 $78.00Failure to turn Failure to stop or yield Failure to inspect Failure to make repairs Speeding - Exceeding the speed limit by: $78.00 $88.00 $98.00 4-124 4-144 8-1 8-4 4-98 1-9 MPH - 10-14 MPH - 15-19 MPH - $78.00 $78.00 $123.00 $123.00 20-24 MPH - $193.00 25-29 MPH - $213.00 30-34 MPH - $233.00 APPEARANCE, GUILTY PLEA AND WAIVER By signing this document, I enter my appearance before the Court to answer the charge contained in this Complaint and Summons. I give up my rights to have a lawyer and a trial. I admit that I committed the offense charged, plead guilty, and make payment of the prescribed penalty. I understand that, except for a parking offense, a record of this conviction will be sent to the Division of Motor Vehicles that issued my license. STATEWIDE VIOLATIONS BUREAU SCHEDULE - COMMONLY CHARGED OFFENSESIf the offense is not listed below, or if it occurred in either a 65 MPH Zone or Construction Zone, please contact the Municipal Court listed above to determine the payable amount. STATEWIDE VIOLATIONS BUREAU SCHEDULE PLEASE READ CAREFULLY 1. PLEA OF NOT GUILTY 2. COURT APPEARANCE REQUIRED If "Court Appearance Required" is checked on this Complaint and Summons (at the bottom of the other side) you must appear in court at the time and place indicated, even if you wish to plead guilty. If "Court Appearance Required" is not checked on this Complaint and Summons, you must still appear in court if: a. you wish to have a trial; or b. the charge is not listed on the State or Local Supplemental Violations Bureau Schedule. 3. PLEA OF GUILTY: PAYMENT THROUGH VIOLATIONS BUREAUIf you wish to plead guilty and give up your rights to have a lawyer and a trial, you may do so provided "Court Appearance Required" has not been checked on this Complaint and Summons and provided the charge is listed on the Violations Bureau Schedule. The more frequently charged State and/or Local Supplemental Violations Bureau off\ enses and prescribed penalties are listed below. You may also telephone the Violations Clerk to determine whether other offenses are listed on either the State or Local Supplemental Violations Bu\ reau Schedules and the amount of the penalty. If the Violations Bureau is authorized to\ dispose of this charge, complete in full the APPEARANCE, GUILTY PLEA AND WAIVER (see below) and bring or mail this Complaint and Summons, together with payment in the amount of the prescribed penalty, to the Violations Bureau at the address indicated below prior to your scheduled court date. If payment is made by mail do not send cash, but send check or money order payable to this Municipal Court. Please print the ticket number on the front of the check or money order. If payment is received by the Violations Bureau after the appearance date, you may be assessed additional penalties. A receipt will be sent to you only if your payment is accompanied by a self-addressed, stamped envelope. Business hrs. Send all payments to: (Defendant's Signature) (Date) Driver's License Number NOTICE PLEASE NOTIFY COURT OF DISABILITY ACCOMMODATION NEEDS. Ord. No. Offense Penalty LOCAL SUPPLEMENTAL VIOLATIONS BUREAU SCHEDULE Ord. No. Offense Penalt y State Exp. Date