I:l JUVENILE OFFENDER

   
 
 
 
  

COMMONWEALTH OF KENTUC 

UNIFORM CITATION
ORI: 

  
 
 
  
    

KSP 206 (REV 2/1/06)



HOME PHONE

 
 
  
  
    

-H AGENCY

 

  
 
 
 

    
   
 

NAME SKIP A SPACE BETWEEN NAM ATTN:



       
 
   



   
 

  

  
 
  
 
 
 
 
 

   
 

  
   

   
 
  

 

      

    

    

 

   
  
 

  
  

  

 

   

I 
c) AUAS 

-4 KENTUCKYRESDENTSTATUS
ECI FULL TIME RI: PART TIME NON RESIE
3: STATE: MARRALSTATUS
DC
LU In ID.NUM8ER 

If DATE OF BIRTH SEX RACE 
LL
AMINOMN
0 a CI FEMALE I-IITE BLACK CI OR ALASKAN EI ASIAN I3 HISPANIC CI NON HISPANIC

     
  

    
    
  

     

     

PLACE OF EMPLOYMENT OCCUPATION CITY STATE HEIGHT WEIGHT HAIR COLOR EYE CO

         

      
   

     
  
 
     
     
   
 

     
     
       

        

VE MAKE


REGI

  

     

VEH. TYPE YEAR

A


REGISTRATION NO.
EXACT LOCATION OF VIOLA

AI

DIRECTION

COLOR 


ALCOHOLIDRUG INVOLVEMENT (SPECIFY)

NO EYES UNK
HICLE IDENTIFIERS

/z

  
    
   

      

     
    
   
  
 

        

     
     
      

ATE REG. YEAR MPH IN MPH ZONE 

    
         
   
  



VIOLATION DATE VIOLA

070

DATE OF ARREST

I9 I

VIOLATION
CODE

6

 
  
 
 
  
 
  

      

  
 
  
 

  
   

TIME ABRES BA. RESULTS

   
  
 

   



  

I
TIME OF ARREST



STATUTE 0RD.



 

    

     

     
 
 
     
   

MILES



CHARGES

COUNTY OF VIOLATION

 

      
      

    

DATE TIME VEHICLE

   
      

     



FINE

       
    

    

   

  
  

 
   
    

 
   

FINAL DISPN.
TION CODE CODE

JAIL 
PRISON

  

PR
TI

COSTS

    

     


PLEA ING

    
 

    
  

   

  

1

2

 
 
 



 
  
 

3

   

4
COURT LOCATION

PO T-ARRESTCOMPLA V4 ., A 
?15195}? V5.64 [6145?], (ff/75% K?zm

   
  
  
  
  
 

         

  

   
 
   
 

COURT DATE

   
 
  

COURT TIME COURT CASE NO.

   
   

DISPN. DATE TRIAL


CLE

YABLE I3 

COURT

EIJ
EIN

   
  
 
 

 


0

  

COURT

         

 

      

   

I 9

 

COMPLAINT

  
 
  

   



COMMERCIAL VEHICLE ERIE

CDL LICENSE - CI Yes

     
  

 

PLACARDED HAZARDOUS VEHICLE Yes

       

CDL CLASS IDA CI 

     
  
   
 

  

NAME OF WITNESS

 

ADDRESS


ADDRESS

  
     

NAME OF WITNESS
CASE NO.

 

 

  
   
   

CARRIED FOR UCR BY CONTRIBUTOR: 

Ar'H?klf?Xl. ?r?Ir??ll?\I

\J'u-Iulruu . . .

       

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