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XXXXX

MIAMI SYSTEMS CORP., CLIFTON, NJ 973-773-8800

XXXXXX

No.
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 THE UNDERSIGNED CERTIFIES THAT Initial Last STATE Commercial License

Name
Address

First

(Please Print)

City Birth Date Eyes
C O D E

State Sex Weight

Zip Code
C O D E

Telephone Restrictions
C O D E

Height

DID UNLAWFULLY (PARK) (OPERATE) A Make Of Vehicle Lic. Plate No. Year State Body Type Exp. Date Hazardous Material Offense Date LOCATION OF OFFENSE Municipality Month Day Year Describe Location Mun. Code (Offense) Time Hour : : AM PM Color Commercial Vehicle

CODE

County

AND DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE (ONE CHARGE PER COMPLAINT)

TRAFFIC OFFENSES - (check one) - TITLE 39:
1 2 3 4 5 6

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 13 4-98 Speeding

7 8 9 10 11 12

MPH in a

4-85 Improper passing 4-97 Careless driving 4-124 Failure to turn 4-144 Failure to stop or yield 8-1 Failure to inspect 8-4 Failure to make repairs MPH zone

IN EXCESS OF SPEED LIMIT BY:

1-9 MPH 10-14 MPH 65 MPH Zone

15-19 MPH

20-24 MPH

25-29 MPH 30-34 MPH Construction Zone

PENALTY SCHEDULE ON REVERSE
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 Month Day OFFENSE AND WILL FILE THIS COMPLAINT IN THIS COURT CHARGING YOU WITH THAT OFFENSE.

Year

Signature of Complaining Witness

Officer's ID. No.

NOTICE TO APPEAR


CONDITIONS

COURT APPEARANCE REQUIRED

COURT DATE

Month

Day

Year

Time Hour

: :

AM PM

Truck
AREA ROAD TRAFFIC VISIBILITY

Accident Business Dry Light Clear

Personal Injury School Wet Medium Rain VASCAR
Operator ID No.

Property Damage Residential Rural Snow Ice Heavy Snow Fog Radar Breathalyzer
Unit Code

Equipment

Helicopter

Pace

Equipment Operator's Name

CPO 171C (12/99)

Court's Original Copy - White

BENCH WARRANT BAIL INFORMATION
Failed to Appear Date Warrant Date Bail Amount $ Forfeited Return / /

/

/
(Signature and title of person issuing warrant) (Signature and title of person setting bail) / / (Date) (Signature of Judge)

Ordered by: Set by: Reinstated

FIRST APPEARANCE, ARRAIGNMENT AND COUNSEL INFORMATION
First Appearance Date: Advised of Rights: By: Counsel assigned: Counsel retained: Counsel waived: Y Y Y N N N

/

/

Arraignment Date: Defendant Desires Counsel:

/
Yes

/
No

(If yes, name of counsel) (If yes, name of counsel) (If yes, name of Judge accepting waiver)

Name of Prosecuting Attorney: Affiliation: Municipal County State Other (list)

MISCELLANEOUS INFORMATION
Additional Information and Judge's Notes:

Adjournment Requested by

Reason

To

/ /
See attached sheet for additional Judge's notes or other information.

/ /

EVENT
Complaint Amended To: Plea and Date: G NG G Costs $ DWI $ Other $ NG /

COURT ACTION

/ / /

Finding or Dismissal; Date: Fine $ VCCB $ Other $ Period of D.L. Suspension:

DISMISSED Contempt $ SNSF $ Total $

IDRC:
Jail Term / Jail Credit:

Comm. Serv.: Credit for

Signature of Judge:
Court's Copy

Date:

/

/

Court's Original Copy - Back

XXXXX

MIAMI SYSTEMS CORP., CLIFTON, NJ 973-773-8800

XXXXXX

No.
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 THE UNDERSIGNED CERTIFIES THAT Initial Last STATE Commercial License

Name
Address

First

(Please Print)

City Birth Date Eyes
C O D E

State Sex Weight

Zip Code
C O D E

Telephone Restrictions
C O D E

Height

DID UNLAWFULLY (PARK) (OPERATE) A Make Of Vehicle Lic. Plate No. Year State Body Type Exp. Date Hazardous Material Offense Date LOCATION OF OFFENSE Municipality Month Day Year Describe Location Mun. Code (Offense) Time Hour : : AM PM Color Commercial Vehicle

CODE

County

AND DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE (ONE CHARGE PER COMPLAINT)

TRAFFIC OFFENSES - (check one) - TITLE 39:
1 2 3 4 5 6

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 13 4-98 Speeding

7 8 9 10 11 12

MPH in a

4-85 Improper passing 4-97 Careless driving 4-124 Failure to turn 4-144 Failure to stop or yield 8-1 Failure to inspect 8-4 Failure to make repairs MPH zone

IN EXCESS OF SPEED LIMIT BY:

1-9 MPH 10-14 MPH 65 MPH Zone

15-19 MPH

20-24 MPH

25-29 MPH 30-34 MPH Construction Zone

PENALTY SCHEDULE ON REVERSE
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 Month Day OFFENSE AND WILL FILE THIS COMPLAINT IN THIS COURT CHARGING YOU WITH THAT OFFENSE.

Year

Signature of Complaining Witness

Officer's ID. No.

NOTICE TO APPEAR


CONDITIONS

COURT APPEARANCE REQUIRED

COURT DATE

Month

Day

Year

Time Hour

: :

AM PM

Truck
AREA ROAD TRAFFIC VISIBILITY

Accident Business Dry Light Clear

Personal Injury School Wet Medium Rain VASCAR
Operator ID No.

Property Damage Residential Rural Snow Ice Heavy Snow Fog Radar Breathalyzer
Unit Code

Equipment

Helicopter

Pace

Equipment Operator's Name

CPO 171C (12/99)

Police Copy - Blue

DISPOSITION OF CASE
DATES OF ADJOURNMENTS: FROM: REASON: FROM: REASON: DISPOSITION DATE: BY: PLEA: COURT VIOLATIONS BUREAU FINDING:

/

/

TO:

/

/

/

/

TO:

/

/

BAIL INFORMATION
BAIL AMOUNT $ POSTED WITH: CASH BOND

(NAME & TITLE) BAIL FORFEITURE:

AMOUNT $

DATE

/

/

SENTENCE
FINE $ COSTS $ $ $ $ $ JAIL: DR. LIC. REVOKED: REVOCATION DATE: DAYS: DAYS

/

/

OFFICER'S COMMENTS
(See Instructions On Cover)

WITNESSES: (NAME & ADDRESS)
1.

SUBPOENA ISSUED
YES NO

2.

3.

Police Copy - Blue - Back

XXXXX

MIAMI SYSTEMS CORP., CLIFTON, NJ 973-773-8800

XXXXXX

No.
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 THE UNDERSIGNED CERTIFIES THAT Initial Last STATE Commercial License

Name
Address

First

(Please Print)

City Birth Date Eyes
C O D E

State Sex Weight

Zip Code
C O D E

Telephone Restrictions
C O D E

Height

DID UNLAWFULLY (PARK) (OPERATE) A Make Of Vehicle Lic. Plate No. Year State Body Type Exp. Date Hazardous Material Offense Date LOCATION OF OFFENSE Municipality Month Day Year Describe Location Mun. Code (Offense) Time Hour : : AM PM Color Commercial Vehicle

CODE

County

AND DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE (ONE CHARGE PER COMPLAINT)

TRAFFIC OFFENSES - (check one) - TITLE 39:
1 2 3 4 5 6

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 13 4-98 Speeding

7 8 9 10 11 12

MPH in a

4-85 Improper passing 4-97 Careless driving 4-124 Failure to turn 4-144 Failure to stop or yield 8-1 Failure to inspect 8-4 Failure to make repairs MPH zone

IN EXCESS OF SPEED LIMIT BY:

1-9 MPH 10-14 MPH 65 MPH Zone

15-19 MPH

20-24 MPH

25-29 MPH 30-34 MPH Construction Zone

PENALTY SCHEDULE ON REVERSE
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 Month Day OFFENSE AND WILL FILE THIS COMPLAINT IN THIS COURT CHARGING YOU WITH THAT OFFENSE.

Year

Signature of Complaining Witness

Officer's ID. No.

NOTICE TO APPEAR


CONDITIONS

COURT APPEARANCE REQUIRED

COURT DATE

Month

Day

Year

Time Hour

: :

AM PM

Truck
AREA ROAD TRAFFIC VISIBILITY

Accident Business Dry Light Clear

Personal Injury School Wet Medium Rain VASCAR
Operator ID No.

Property Damage Residential Rural Snow Ice Heavy Snow Fog Radar Breathalyzer
Unit Code

Equipment

Helicopter

Pace

Equipment Operator's Name

CPO 171C (12/99)

Officer's Copy - Yellow

DISPOSITION OF CASE
DATES OF ADJOURNMENTS: FROM: REASON: FROM: REASON: DISPOSITION DATE: BY: PLEA: COURT VIOLATIONS BUREAU FINDING:

/

/

TO:

/

/

/

/

TO:

/

/

BAIL INFORMATION
BAIL AMOUNT $ POSTED WITH: CASH BOND

(NAME & TITLE) BAIL FORFEITURE:

AMOUNT $

DATE

/

/

SENTENCE
FINE $ COSTS $ $ $ $ $ JAIL: DR. LIC. REVOKED: REVOCATION DATE: DAYS: DAYS

/

/

OFFICER'S COMMENTS
(See Instructions On Cover)

WITNESSES: (NAME & ADDRESS)
1.

SUBPOENA ISSUED
YES NO

2.

3.

Officer's Copy - Yellow - Back

XXXXX

MIAMI SYSTEMS CORP., CLIFTON, NJ 973-773-8800

XXXXXX

No.
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 THE UNDERSIGNED CERTIFIES THAT Initial Last STATE Commercial License

Name
Address

First

(Please Print)

City Birth Date Eyes
C O D E

State Sex Weight

Zip Code
C O D E

Telephone Restrictions
C O D E

Height

DID UNLAWFULLY (PARK) (OPERATE) A Make Of Vehicle Lic. Plate No. Year State Body Type Exp. Date Hazardous Material Offense Date LOCATION OF OFFENSE Municipality Month Day Year Describe Location Mun. Code (Offense) Time Hour : : AM PM Color Commercial Vehicle

CODE

County

AND DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE (ONE CHARGE PER COMPLAINT)

TRAFFIC OFFENSES - (check one) - TITLE 39:
1 2 3 4 5 6

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 13 4-98 Speeding

7 8 9 10 11 12

MPH in a

4-85 Improper passing 4-97 Careless driving 4-124 Failure to turn 4-144 Failure to stop or yield 8-1 Failure to inspect 8-4 Failure to make repairs MPH zone

IN EXCESS OF SPEED LIMIT BY:

1-9 MPH 10-14 MPH 65 MPH Zone

15-19 MPH

20-24 MPH

25-29 MPH 30-34 MPH Construction Zone

PENALTY SCHEDULE ON REVERSE
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 Month Day OFFENSE AND WILL FILE THIS COMPLAINT IN THIS COURT CHARGING YOU WITH THAT OFFENSE.

Year

Signature of Complaining Witness

Officer's ID. No.

NOTICE TO APPEAR


CONDITIONS

COURT APPEARANCE REQUIRED

COURT DATE

Month

Day

Year

Time Hour

: :

AM PM

Truck
AREA ROAD TRAFFIC VISIBILITY

Accident Business Dry Light Clear

Personal Injury School Wet Medium Rain VASCAR
Operator ID No.

Property Damage Residential Rural Snow Ice Heavy Snow Fog Radar Breathalyzer
Unit Code

Equipment

Helicopter

Pace

Equipment Operator's Name

CPO 171C (12/99)

Defendant's Copy (Hard Copy) - Buff

PLEASE READ CAREFULLY 1. PLEA OF NOT GUILTY
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.

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 BUREAU
If 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 offenses 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 Bureau 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.

Send all payments to:

Business hrs.

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.

STATEWIDE VIOLATIONS BUREAU SCHEDULE - COMMONLY CHARGED OFFENSES
If 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
Penalty Offense Penalty Title 39: Offense 4-124 Unregistered vehicle Failure to turn $78.00 $44.00 4-144 Failure to stop or yield $78.00 Failure to exhibit docs. $44.00 8-1 Failure to inspect $123.00 Unclear Plates $44.00 8-4 Failure to make repairs $123.00 Maintenance of lamps $44.00 4-98 Speeding - Exceeding the Failure to wear seatbelt $42.00 speed limit by: Failure to observe signal $78.00 1-9 MPH - $78.00 20-24 MPH - $193.00 10-14 MPH - $88.00 25-29 MPH - $213.00 Improper passing $78.00 15-19 MPH - $98.00 30-34 MPH - $233.00 Careless driving $78.00 LOCAL SUPPLEMENTAL VIOLATIONS BUREAU SCHEDULE Ord. No. Offense Penalty Ord. No. Offense Penalty Title 39: 3-4 3-29 3-33 3-66 3-76.2f 4-81 4-85 4-97

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.

(Defendant's Signature) Driver's License Number

(Date)

State

Exp. Date

NOTICE
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. PLEASE NOTIFY COURT OF DISABILITY ACCOMMODATION NEEDS.

Defendant's Copy (Hard Copy) - Back - Buff