Free Uniform Citation Forms - Oregon


File Size: 734.7 kB
Pages: 10
Date: February 22, 2000
File Format: PDF
State: Oregon
Category: Court Forms - State
Word Count: 4,226 Words, 24,430 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.ojd.state.or.us/web/OJDPublications.nsf/Files/UCFORMS.pdf/$File/UCFORMS.pdf

Download Uniform Citation Forms ( 734.7 kB)


Preview Uniform Citation Forms
1999 Oregon Uniform Citation (UC) Form 1

(Ticket size needed 8" by 5)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

COMPLAINT OREGON UNIFORM CITATION AND COMPLAINT
Use for All Violations or Crimes Where Separate Complaint Will Not Be Filed/ ORS 153.045 or 133.069 9 CRIME(S) (See A on Back)

OR
(Not Both)

9 VIOLATION(S) (See B on Back)

9 Traffic 9 Other 9 Wildlife 9 Boating 9 Commercial Fishing

S T A T E OF O R E G O N CITY/ OTHER PUBLIC BODY _ _ _ _ _ _ _ _ _ _ _ _ _ _ COUNTY OF _ _ _ _ _ _ _ _ _ _ _ _ _ _

) ) )

Docket No. _ _ _ _ _ _ _ _ _ _ _ _ _ Court: 9 Munic ipal 9 Justice 9 Juvenile 9 Circuit for DA use Reserved

DEFENDANT
T H E U N D E R S I G N E D C E R T IF I E S A N D S A Y S T H A T T H E F O L L O W I N G P E R S O N :
ID Type: N a m e: Addre ss: La s t ID No: F ir s t State: MI License Class State: Zip Code: Def. is: 9 Employed to drive
9 Passenger

Tel.No:

City:

9 _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _

Sex: T I M E /P L A C E

Race:

DOB:

Height:

Weigh t:

Hair:

Eyes:

A T T H E F O L L O W I N G T I M E A N D P L A C E I N TH E A B O V E - M E N T I O N E D ST A T E A N D C O U N T Y :
Offense Date on or abo ut: Month Day Year Time 9 AM 9 PM 9 Highway 9 _ _ _ _ _ _ 9 Premis es open to public Court use: for Reserved

At or nea r Location :

REL. INFO
INVO LVIN G TH E FO LLO WIN G:
Type: R e g is / V IN / I D N o State 9 Acciden t 9 Injury 9 Property damage 9 Endanger others 9 Driver not Reg. Owner 9 Haz Material 9 Commercial Veh.

Vehicle year, make, model, style, color; OR Other, describe:

Other:

OFFENSE(S)
DID T HEN AND THE RE C OM MIT THE FOL LOW ING O FFE NSE(S ):
1. Violated (cite ORS/ ORD/rule) Describe Alleged spd Designated Spd 9 Posted L imit 9 VBR 9 9 9 9 Radar Pace Laser ______

9Intentional 9knowing 9reckless 9criminal negligence 9 No culpable mental state 2. Violated (cite ORS/ ORD/rule) Describe

9 Pstd Sch Zn 9 Hwy Wk Zn

1. Base fine:

9 Intention al 9 Knowing 9 Reckless 9 Criminal negligence 9 No culp able men tal state 3. Violated (cite ORS/ ORD/rule) Describe

2. Base fine:

9 Intention al 9 Knowing 9 Reckless 9 Criminal negligence 9 No culp able men tal state

3. Base fine: Expl.

OTH.

I certify under ORS 153.045 and 153.990 and under other applicab le law and under penalties for false swearing, do sw ear/affirm that I have sufficient grounds to and do believe that the above-mentioned defendant/person committed the above offense(s) and I have served the defendant/person with this co mplaint:

O f f ic e r( s ) A g e n cy I D :

1 st Officer ID No: _ _ _ _ _ _ _ __ _ _ _ __ _ _ __ _ _ Date Issued _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ 1st Officer Signature

2 n d Officer ID No:

26 27 28 29

Print 1 st Officer name: 2 nd Officer or arresting person (if not officer): Signature Print name:

Y O U R C O U R T A P P E A R A N C E D A T E , T IM E A N D L O C A T I O N A R E :
Mo/Day/Year Time: 9 AM 9 PM Location :

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

1999 Oregon Uniform Citation (UC) Form 2

(Ticket size needed 8" by 5")

COMPLAINT

OREGON UNIFORM MOTOR CARRIER CITATION AND COMPLAINT
Use for All Violations or Crimes Where Separate Complaint Will Not Be Filed/ ORS 153.045 or 133.069 9 CRIME(S) (See A on Back)

OR

9 VIOLATION(S) (See B on Back)

9 Traffic 9 Other 9 Wildlife 9 Boating 9 Commercial Fishing

STATE OF OREGON CITY OF _ _ _ _ _ _ _ _ _ _ _ _ _ _ COUNTY OF _ _ _ _ _ _ _ _ _ _ _ _ _ _

) ) )

Docket No. _ _ _ _ _ _ _ _ _ _ _ _ _ Court: 9 Municipal 9 Justice 9 Juvenile 9 Circuit for DA use Reserved

DEFENDANT

The Undersigned Certifies and Says That The Following Person: ID No: Fi r st MI License Class State: Zip Code: 9Employed to drive
9 Passenger

ID Type: N a m e : L a st Address:

State:

Tel.No:

City:

9 _ __ _ _ _ _ _ Sex: Race: DOB: Height Weight Hair Eyes

time/place At the Following Time and Place in the Above-mentioned State and County: Offense Date on or about: At Location: Month Day Year Time 9 AM 9 PM 9 Highway 9 _ _ _ _ _ _ 9 Premises open to public Court use: for Reserved

REL. INFO
INVO LVIN G TH E FO LLO WIN G:
Veh. Registration No. State Veh.Yr. Make Model 9 9 9 9 Acciden t 9 Injury Property Damage Endanger Others Hwy work Zone

ODO T NO :

9 Haz. Mat.

9 CDL Related

Comm odity

Owner

Address

City

State

Zip Code

OFFENSE(S)
DID T HEN AND THE RE C OM MIT THE FOL LOW ING O FFE NSE(S ):
1. Violated (cite ORS/ ORD/rule) 9 Overload 9 Axle 9 T a n d em 9 Group 9 Permit Violation 9 Vehicle 9 Comb ination 2. Violated (cite ORS/ ORD/rule) 9 Oversize 9 Width 9 Height 9 Length 9 Permit violation 9 No OD OT Pe rmit 3. Violated (cite ORS/ ORD/rule) Describe

Alleged Wt: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Wt. Lim it: Describe

1. Base fine:

Alleged Size: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Size Limit: Describe

2. Base fine:

3. Base fine: OTHER I certify under ORS 153.045 and 153.990 or other applicable law that I have sufficient grounds to and do believe that the above-mentioned defendant/person committed the above offense(s) and I have served the defe ndant/person with this complaint: Expl. Officer(s) Agency ID:

_ _ _ _ _ _ _ __ _ _ _ __ _ _ __ _ _ Date Issued

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ Officer Signature Officer ID No: Signature Print name:

28 29 30 31 32

Print Officer name: 2
nd

Officer or arresting person (if not officer):

YOUR COURT APPEARANCE DATE, TIME AND LOCATION ARE: Mo/Day/Year Time: 9 AM 9 PM Location:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

1999 Oregon Uniform Citation (UC) Form 3

(Ticket size needed 8" by 5")

COMPLAINT

OREGON UNIFORM BOATING CITATION AND COMPLAINT
Use for All Violations or Crimes Where Separate Complaint Will Not Be Filed/ ORS 153.045 or 133.069 9 CRIME(S) (See A on Back) 9 VIOLATION(S) (See B on Back) 9 Traffic 9 Other 9 Wildlife 9 Boating 9 Commercial Fishing

OR

STATE OF OREGON CITY OF _ _ _ _ _ _ _ _ _ _ _ _ _ _ COUNTY OF _ _ _ _ _ _ _ _ _ _ _ _ _ _ DEFENDANT The Undersigned Certifies and Says That The Following Person: ID Type: Name: Last Address: ID No: First

) ) )

Docket No. _ _ _ _ _ _ _ _ _ _ _ _ _ Court: 9 Municipal 9 Justice 9 Juvenile 9 Circuit for DA use Reserved

State: MI

Tel.No:

License Class

9Employed to drive
9 Passenger 9 _ __ _ _ _ _ _

City:

State:

Zip Code:

Sex:

Race:

DOB:

Height

Weight

Hair

Eyes

time/place At the Following Time an Place in the Above-mentioned State and County: d Offense Date on or about: At Location: Month Day Year Time 9 AM 9 PM 9 Highway 9 _ _ _ _ _ _ 9 Premises open to public Court use: for Reserved

REL. INFO.
I N V O L V IN G T H E F O L L O W I NG :
Vessel Registration No: Make Length Regis Expires: Mo Hull Id No: Day Year 9 Defendant not registered owner 9 Acciden t 9 Property damage 9 Endanger others 9 Injury

OPERATION
DID T HEN AND THE RE C OM MIT THE FOL LOW ING O FFE NSE(S ) (UP T O 3 O FFE NSES ):
Off# _ _ _ _ _ 9 Speed/wake/motor 9 830.180 9 830.185 9 Radar 9 250. _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 9 Towing without an observer 9 Water skiing or similar activity, 830.365 Designated: Alleged:

9 Skier down flag

EQUIPMENT
Off# _ _ _ _ _

9 Personal flotation device, 830.2 15 9 Insufficient number 9 Not approved 9 Not accessible 9 Defective 9 No thro wable 9 Navigation lights, 830.2 25 9 Operatin g witho ut 9 Improper 9 None/in adequa te 9 Not approved

Persons:

PFDs:

9 Mufflers/excessive noise, 830.260 9 Fire extinguisher, 830.220

9 Measu red level

Noise L evel: 9 Not acce ssible

OAR 250-10-121

9 Insufficient no.

9 Discharged

RETIS.
Off# _ _ _ _ _

9 Certificate o f Num ber 830 .770: 9 Not aboard 9 Expired 9 Identifyin g Num ber 830 .780: 9 Incorrect display 9 Not displayed 9 Validatio n stickers , 830.79 5: 9 Incorrect or not displayed 9 Expired

9 Not applied for 830.785

1. Base Fine 1st off: $ 2. Base Fine 2nd off: $ 3. Base Fine 3rd off: $

Off# _ _ _ _ _ (cite ORS/ ORD/rule) OTHER I c e r t i fy

9 Other

Describe

Expl. Officer(s) Agency ID:

u n d e r O R S 1 5 3 . 04 5 a n d 1 5 3 . 9 9 0 o r o t h e r a p p l i c a b le l a w t h a t I h a v e s u ff i c i e n t g r o u n d s to a n d d o b e l ie v e t h a t th e a b o v e - m e n t i n e d d e f e n d a nt / p e r so n o comm itted the abo ve offense (s) and I have served the d efendan t/person w ith this comp laint:

_ _ _ _ _ _ _ __ _ _ _ __ _ _ __ _ _ D a t e I s s ue d

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ Officer Signature

31 32 33 34 35

Print Officer name: 2 Officer or arresting person (if not officer):
nd

Officer ID No: Signature Print name:

YOUR COURT APPEARANCE DATE, TIME AND LOCATION ARE: Mo/Day/Year Time: 9 AM 9 PM Location:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

1 9 9 9 O r e go n U n if o rm C i ta t io n (U C ) F or m 4

(Ticket size needed 8" by 5")

COMPLAINT

OREGON UNIFORM FISH/WILDLIFE CITATION AND COMPLAINT
U s e f o r A l l V i o l a t io n s o r C r im e s W h e r e S e p a r at e C o m p l a i n t W i l l N o t B e F il e d / O R S 1 5 3 .0 4 5 o r 1 3 3 . 06 9 9 CRIME(S) (See A on Back)

OR

9 VIOLATION(S) (See B on Back)

9 T r a f f i c 9 Other 9 W i l d l i f e 9 B o a t i n g 9 C o m m e r c i a l F is h i n g

STATE OFOREGON CITY OF _ _ _ _ _ _ _ _ _ _ _ _ _ _ COUNTY OF _ _ _ _ _ _ _ _ _ _ _ _ _ _

) ) )

Docket No. _ _ _ _ _ _ _ _ _ _ _ _ _ Court: 9 Municip al 9 J u s t i c e 9 J u v e n i l e 9 Circuit f o r Ds e ru seed Re A v

DEFENDANT
T h e U n d e r s i g n e d C e r ti f i e s a n d S a y s T h a t T he F o l l o w i n g P e r s o n :

ID Type:

ID No:

State:

Tel.No:

N a m e : L a st

F i rs t

MI

Address:

License Class

9 Employ ed to drive

City:

S t a te :

Zip Code:

9 Passenger 9 _ __ _ _ _ _ _

Sex:
time/place

Race:

DOB:

Height

Weight

Hair

Eyes

At the Following Time and Place in the Above-mentioned State and County: Offense Date on or about: At Location: Month Day Year Time 9 AM 9 PM 9 Highway 9 _ _ _ _ _ _ 9 Premises open to public
C o u re su s e :e d f o r R t erv

REL. INFO
INVO LVIN G TH E FO LLO WIN G: Boat/Vehicle Regis or License No: State 9 Accident 9 Injury 9 Property damage 9 Endanger others

Describe: (year, make, model, length, color, other) Hunting/Angling License No: Unit No. Stream No.

OFFENSE(S)
1. Violated (cite ORS/ ORD/rule)

DID T HEN AND THE RE C OM MIT THE FOL LOW ING O FFE NSE(S ): Describe

9Intentional 9 Knowing 9 Reckless 9 Criminal negligence 9 No culpable mental state 2. Violated (cite ORS/ ORD/rule) Describe

1. Base fine:

9Intentional 9 Knowing 9 Reckless 9 Criminal negligence 9 No culpable mental state 3. Violated (cite ORS/ ORD/rule) Describe

2. Base fine:

9Intentional 9 Knowing 9 Reckless 9 Criminal negligence 9 No culpable mental state
OTHER

3. Base fine:
Expl.

I certif under ORS 153.0 45 and 153.990 or other applicabl law that I have sufficient grounds to and do belie ve that t e above-menti oned defendant/per y e h son committed the above offense(s) a nd I have s erved the d efendan t/person w ith this comp laint:

O f f ic e r (s ) A ge n c y I D :

_ _ _ _ _ _ _ __ _ _ _ __ _ _ __ _ _ Date Issued

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ Officer Signature

29 30 31 32 33

Print Officername:

Officer ID No:

2

nd

Officer or arresting person (if not officer):

Signature

Print name:

YOUR COUR T APPEARANCE DA TE, TIME AND LOCATION ARE:

Mo/Day/Year

Time: 9 AM 9 PM

Location :

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

1999 Oregon Uniform Citation Form 5

(Ticket size needed 8" by 5")

OREGON UNIFORM CRIMINAL CITATION
Use for All Citable Crimes Where Separate Complaint Will Be/Has Been Filed /ORS 133.068 See Back of Summons 9 Traffic 9 Other 9 Wildlife 9 Boating 9 Commercial Fishing

CITATION

S T A T E OF O R E G O N CITY/ OTHER PUBLIC BOD Y _ _ _ _ _ _ _ _ _ _ _ _ _ _ COUNTY OF _ _ _ _ _ _ _ _ _ _ _ _ _ _

) ) )

Docket No. _ _ _ _ _ _ _ _ _ _ _ _ _ Court: 9 Munic ipal 9 Justice 9 Juvenile 9 Circuit for DA use Reserved

DEFENDANT
T H E U N D E R S I G N E D C E R T IF I E S A N D S A Y S T H A T T H E F O L L O W I N G P E R S O N : ID type: Name: Last Address: ID No: First State: MI License Class State: Zip Code: 9 Employed to drive Tel. No.

City:

Def. Is: 9 Passenger 9 ______________ Weight Hair Eyes

Sex:

Race:

DOB:

Height

TIME/PLACE
A T T H E F O L L O W I N G T I M E A N D P L A C E I N TH E A B O V E - M E N T I O N E D ST A T E A N D C O U N T Y : Offense Date on or about: Month Day Year Time 9 AM 9 PM 9 Highway 9 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 9 Premises open to public
court use: Reserved for

At or near Location:

OFFENSE(S)
DID T HEN AND THE RE C OM MIT THE FOL LOW ING O FFE NSE(S ): 1. Violated (cite ORS/ ORD/rule) Describe

9 Intentional 9 Knowing 9 Reckless 9 Criminal negligence 9 No culpable mental state
2. Violated (cite ORS/ ORD/rule) Describe

9 Intentiona l 9 Knowing 9 Reckless 9 Criminal negligence 9 No culp able men tal state 3. Violated (cite ORS/ ORD/rule) Describe

9 Intentiona l 9 Knowing 9 Reckless 9 Criminal negligence 9 No culp able men tal state

OTH.

Expl.

I certify and swear/affirm under applicable law that I have sufficient grounds to and do believe that the above-mentioned defendant/person committed the above offense(s) and I have served the defendant/person with this citation:

Officer(s) Agency ID:

1st Officer ID No: _ _ _ _ _ _ _ __ _ _ _ __ _ _ __ _ _ Date Issued __________________________________________ _ 1st Officer Signature 2n d Officer ID No: Signature 9 No BY: Print name:

29 30 31 32 33

Print 1st Officer name: 2nd Officer or arresting person (if not officer):

Complaint or information filed at time of citation: 9 Yes

Y O U R C O U R T A P P E A R A N C E D A T E , T IM E A N D L O C A T I O N A R E : Mo/day/year Time: 9 AM 9 PM Location:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

1999 Oregon Uniform Citation (UC) Form 6
Ticket size needed 8" by 5"

Back o f comp laint/abs tract pag es of AL L citatio ns.

REC ORD AND : 9 Circuit Court Register 9 Justice C ourt Doc ket 9 Municipal Court Docket HAN DLED BY: 9 VIOLATIONS BUREAU BASE D ON : 9 WRITTEN SUBMISSION 9 COURT 9 APPEARANCE
DATE EVENT/NOTES COMPLAINT FILED WRITTEN RESPONSE RECEIVED ARRAIGNED 9 MISD. 9 VIOL. 9 161. 566 OR 9 161.568 (reduction) INITIAL

SECURITY RELEASE AT: $ COURT/JURY TRIAL CRIMINAL RIGHTS GIVEN ATTORNEY: WARRANT ORDERED: DIVERSION AGREEMENT: CONTINUED TO: 9 ORS 135.355 CONDITIONAL PLEA REASON: OSB#: ISSUED:

RECEIPT NO: (9 WAIVED)

(9 WAIVED)

The attached additions to this record/register are incorporated by reference, see page(s): 9 1 (by _ _ _ _); 9 2 (by _ _ _ _).

JUDGMENT OF THE COURT (SUBMIT ABSTRACT COPY UNDER ORS 153.111)
OFF # RESPONSE/PLEA CHANGE PLEA F I N D IN G D E T E R M IN A T I O N OFFENSE CITE TYPE CLASS

1 2 3

G NG NC FTA G NG NC FTA G NG NC FTA

G NG G NG G NG

C A Dism C A Dism C A Dism

VM VM VM

A B C D Oth A B C D Oth A B C D Oth

DISPOSITION: 9 137.533 Deferred Sentence 9 Sent.Imp.Sus. 9 Dr. Priv. Susp. _ _ _ _ _ _ _ _ _ _ _ _ (Time) Conv. Spd. _ _ _ _ _ _ JAIL: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Probation/Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _________________________________________________________________________ The attached additions to this judgment are incorporated by reference, see page(s): 9 1 (by _ _ _ _); 9 2 (by _ _ _ _); 9 3 (by _ _ _ _). MONEY JUDGMENT MONEY OBLIGATION FINE COSTS 137.309 ASSESSMENT UNITARY ASSESSMENT RESTITUTION OFFENSE 1 IMPOSE SUSPEND IMPOSE OFFENSE 2 SUSPEND OFFENSE 3 IMPOSE SUSPEND

TOTALS TOTAL AMOUNT TO PAY THAT IS NOT SUSPENDED (FROM OFFENSES, 1, 2, AND 3) $ _ _ _ _ _ _ _ _ _ _ _ _ _ TERMS OF PAYMENT: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _______________________________________________________________________ 9 All moneys, including suspended moneys, become due immediatelyunder ORS 153.090(4) if nonsuspended moneys not paid in accordance with terms of payment. The attached additions to this MONEY judgment are incorporated by reference, see page(s): 9 1 (by _ _ _ _); 9 2 (by _ _ _ _). Judgment Creditor: 9 State of Oregon 9 Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Judgment Debtor: 9 Defendant 9 Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ______________ Date ____________________________________ Signature of: 9 Judge (9 Violations Clerk, where allowed)

1

1999 Oregon Uniform Citation (UC) Form 7. Ticket size n eeded 8" b y 5". ISSUING OFFIC ER'S AF FIDAV IT I hereby depose and state the following:

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

Defendant Fing er Print:
9R9L 9T92 9394 95

Defendant Fing er Print:
9R9L 9T92 9394 95

RELEVANT CONDITIONS:
Bad Road Surface: 9 Wet 9 Snow 9 Ice Limited Visibility: 9 Night 9 Rain 9 Snow Other:

Traffic: 9 Light

9 Medium

9 Heavy

At Intersec tion: 9 Controlled 9 Uncontrolled Area: 9 Business

9 Drwy./Alley

9 Fog

9 School

9 Residential

I swear/affirm to the abo ve-stated facts _____________ Date _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Officer Signature _ _ __ _ _ _ _ _ _ ID No.

Subscribed and sworn to before me this _ _ _ _ _ _ day of _ _ _ _ _ _ _ _ _ _ _ _ _ _ , 2 _ _ _ _ _

_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Clerk/Notary Public for Oregon My Comm ission expires _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

1999 Oregon Uniform Citation (UC) Form 8. Ticket size n eeded 8" b y 5". ISSUING OFFIC ER'S AF FIDAV IT I hereby depose and state the following:

Defendant Fing er Print:
9R9L 9T92 9394 95

Defendant Finger Print:
9R9L 9T92 9394 95

WATER TRAFFIC 9 Light 9 Medium 9 Heavy

GENERAL CONDITIONS
LOCALE 9 Open 9 Restricted VISIBILITY 9 Clear 9 Fog 9 Dark 9 Rain 9 Person 9 Boat 9 Other

SITUATIONS 9 Struck 9 Nearly struck 9___________

I swear/affirm to the above-state facts __________ Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ Officer Signature __________ ID No.

Subscribed and sworn to before me this _ _ _ _ day of _ _ _ _ _ _ _ _ _ _ _ _ _, 2 _ _ _ _ _

_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Clerk/Notary Public for Oregon My Commission expires _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date

35

5 6 7 8 9 10 11 12 13 14 15 16

1 2 3 4

1999 Oregon Uniform Citation (UC) Form 9, Back of summons copy of all uniform citation forms except Form 5, Ticket size needed 8" by 5"
A COMPLAINT ON THIS CITATION WILL BE FILED AGAINST YOU IN THE COURT INDICATED ON THE FRONT OF THIS SUM MONS.

READ CAREFULLY
If the front of this ticket shows you are charged with a: A. C R I M E, Y OU M UST APPEAR at the tim e and pla ce set by this sum mons. B. V I O L A T IO N, You must do one (and only one) of the viola tion op tion s lis te d b e low . V IOL AT ION OPTIONS TO RESPOND TO VIOLATION(S) CHARGED ON THIS SUMM ONS, YOUR OPTIONS ARE: OP T ION 1 PERSONALLY APPEAR at the court at the appearance time indicated to enter a plea

OR, before that time, to orally request a trial. You have a right to trial, and if you plead not guilty when you appear, the court will set a date and time for trial.

17

OP T ION 2

ENTER A PLEA OF GUILTY OR NO C ONT EST b y writ ten ap peara nce. To choose this option do all the following before the time this summons requires you to appear :

18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

1. Check A ND initial one (and only one) of the following pleas:

9 I Plead GUILTY _ _ _ _ _ _ (initial)

9 I Plead NO CONTEST _ _ _ _ _ _ (initial)

2. Sign/date here: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (signature), _ _ _ _ _ _ _ _ (date), AND 3. Deliver to the court this summ ons (see notice "4" below) and attach a written state ment expla ining or in mitigati on of the violation (s) char ged (if y our plea is GU ILTY , the wr itten state ment is o ptional) , AND 4. With this summons, send or take the court a check or money order for the full base fine amount as shown on this su mmon s ($ _ _ _ _ _ _ _ _ _ _ _ indica te amo unt enc losed). IMPORTA NT: Choosing this option makes a written appearance and waives your right to trial. If you plead GUILTY, you agree to the penalties for your offense. If you plead NO CONTEST, you consent to any court judgment based on your plea and statement and the officer's report. If it finds you guilty, the court may keep all or part of the money you pay, but will return any left after taking out the sanction amount. If you choose this option, the court will not fine you more without giving you notice to come to a hearing.
OP T ION 3

ENTE R A PL EA OF NOT G UILTY by writt en appe arance. T o choose t his option do all the following before the time this summons req uires you to appear :

35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72

1. Sign/date here: _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ (signature), _ _ _ _ _ _ _ _ (date), AND 2. Deliver to the court this su mmons b y itself or with a written re quest for trial ( see notice "4" below). IMPORTA NT: Choosing this option makes a written request for hearing. The court will give you notice of the time and place when you MUST appear. The court may impose penalties if you do not appear at the time given in the notice. The court may require you to deposit money to assure your appearance if you have failed to appear on any o ffense c harges in the pa st.
OP T ION 4

Contact the Court Clerk, before the time this summon s requires you to appear, and determine if you qualify for a trial by affidavit under ORS 153.080.

If so, the trial will be based upon sworn, written statements and future court appearances may not be necessary. It is possible that you may not qualify for trial by affidavit or that the local court may not offer the o ption. In th ose cas es, you m ust com ply with one of the other opt ions. NOTICE 1. In any case, the court, AFTER NOTICE, MAY REQUIRE YOU TO APPEAR FOR A HEARING. 2. For traffic offenses, this record will be sent to the Licensing Authority of this state (or where you received your lice nse to dr ive) to de cide if a license suspens ion is app ropriate . 3. For violations, if you are going to have an attorney represent you, you must notify the court and the prosec utor's of fice in a dvance . 4. YO U MA Y MA IL WR ITTEN APPE ARA NCE S to the c ourt und er Vio lation O ptions 2 o r 3 abov e, but the mail must arrive at the cour t before your appearan ce date shown on this sum mons. WARNING 1. IF YOU FAIL TO FOLLOW THESE INSTRUCTIONS, THE COURT MAY ISSUE A WARRANT FOR YOUR ARREST and/or, for traf fic offe nses, m ay orde r your lic ense su spende d. 2. For violations, if you do not pay the full base fine in advance and do not appear, the court, without further hearing, may enter a conviction and a judgment against you for more than the base fine and up to the maximum penalty allowed by law for the charged offense(s) including the maximum fines, assessments, restitution and other co sts (wh ich ma y be sub stantially more th an the b ase fine ).

MA IL C OR R E S PONDENCE OR W RI TTEN APPEARANCE AND M A K E CH E CK S PA Y A BLE T O :

1 2 3 4

1999 Oregon Uniform Citation (UC) Form 10, Back of summons copy of Form 5

5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

You have been issued a citation for a crime as indicated on the front of this summons. READ CAREFULLY This citation is not a complaint or an information. A complaint or an information may be filed and you will be provided a copy thereof at the time of your first appearance. You MUST appear in court at the time set in the citation. IF YOU FAIL TO APPEAR AND A COMPLAINT OR INFORMATION HAS BEEN FILED, THE COURT WILL IMMEDIATELY ISSUE A WARRANT FOR YOUR ARREST. The date and time when and location where you must appear are shown on the front of this summons.