Form 701 8/04 SML
Vermont Judicial Bureau
P.O. Box 607 White River Junction, Vermont 05001 (802) 295-8869
POLICE BATCH FORM
Please Complete
1. 2. 3. 4. Police Department Name Address Town Zip 5. 6. 7. 8. 9. 10.
This batch contains the following tickets:
11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
/ /
Vt.
Distribution: Original ~ Police
2nd and 3rd copies ~ Judicial Bureau
Signature
Date
Form 701 8/04 SML
Vermont Judicial Bureau
P.O. Box 607 White River Junction, Vermont 05001 (802) 295-8869
POLICE BATCH FORM
Please Complete
1. 2. 3. 4. Police Department Name Address Town Zip 5. 6. 7. 8. 9. 10.
This batch contains the following tickets:
11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
/ /
Vt.
Distribution: Original ~ Police
2nd and 3rd copies ~ Judicial Bureau
Signature
Date
Form 701 8/04 SML
Vermont Judicial Bureau
P.O. Box 607 White River Junction, Vermont 05001 (802) 295-8869
POLICE BATCH FORM
Please Complete
1. 2. 3. 4. Police Department Name Address Town Zip 5. 6. 7. 8. 9. 10.
This batch contains the following tickets:
11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
/ /
Vt.
Distribution: Original ~ Police
2nd and 3rd copies ~ Judicial Bureau
Signature
Date