COURT
LOCATION
COURT DATE
UNIFORM SUMMONS & COMPLAINT OR PENALTY ASSESSMENT
THE PEOPLE OF THE STATE VS:
SSN:
ROAD
CODE
MILE
POST
(First)
(Middle)
Date of Birth Mo. Day Yr. Age
Defendant’s Address
City
State
Zip Code
THIS IS A LEGAL DOCUMENT READ BOTH SIDES
CHARGE(S)
Driver’s License Number and Type
State
Race
Employer Name
Employer Address
Vehicle License Number and Type
State
Vehicle Color (Top/Bottom)
VIN
Sex
Height
Weight
Hair
Eyes
Occupation
Vehicle Year
Make
ACF
954434
Violation Mo. Day Yr.
Direction of Travel
N S E W
Home Telephone
County
Business Telephone
Type or Body Style
NO.
CR
( ) Traffic ( ) Penal
Approx. Time of Violation
No.
Traffic Accident
( ) Yes ( ) No
Injuries Involved
( ) Yes ( ) No
COURT
Defendant (Last Name)
Approximate Location of Violation, State of Colorado
( ) On______________________Miles__________From__________________
( ) At Intersection With:
YOU ARE SUMMONED AND ORDERED TO APPEAR
TO ANSWER CHARGES AS STATED BELOW IN:
At: 1035 Main St.
In: Orchard City, State
Aspen County Court
At: 901 9th Ave.
In: Treetop, State
CRS
CRS
SECTION
CODE
SECTION
CODE
SUMMONS TRAFFIC INFRACTION ( )
PENALTY ASSESSMENT
OFFENSE ( )
TRAFFIC INFRACTION ( )
20_____ At ____________ M
FINE
SURCHARGE
$
$
FINE
SURCHARGE
$
$
OFFENSE ( )
POINTS
POINTS
MAILED ( )
Without admitting guilt, I promise to appear
at the time and place indicated above:
My signature is a promise to pay this penalty assessment within 20 days. With payment,
I acknowledge guilt of all charges listed above and understand that the points indicated
will be assessed against my driver’s license. If I do not pay, my signature is a promise to
DEFENDANT ________________________ appear in court.
NOTICE: SEE INSTRUCTIONS ON
REVERSE SIDE
DEFENDANT _______________________________________________________________
NOTICE: SEE INSTRUCTIONS ON REVERSE SIDE
DISTRICT
TROOP
PATROL
DATE
ISSUED
MO.
DAY
YR.
OFFICER-PRINT LAST NAME____________________________
OFFICER ____________________________________________NO. ______________________________
NAME OF
OFFICER
REASON FOR
TICKET
Answer the question.
Questions
What does “charges” mean?
What is another word for “what you need to pay”?
Who is the “defendant”?
When does the driver have to pay the fine?
What is the other option, if you don’t want to pay the fine?
Day 4
ORCHARD CITY POLICE DEPT.
Crab Tree County Court
Traffic Ticket Handout
WHAT YOU NEED
TO PAY