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FLORIDA UNIFORM TRAFFIC CITATION :AGENCY

IN THE COURT DESIGNATED BELOW THE UNDERSIGNED CERTIFIES THAT HEISHE COM PLAI NT
HAS JUST AND REASONABLE GROUNDS TO BELIEVE AND DOES BELIEVE THAT ON (RETAINED BY COURT)

DAY WEEK DAM
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4/050! AH 
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(18.15237/?

NISIIEJINEIER CDL LICENSE YR. LICENSE EXP. IF COMMERCIAL MTR

VEH. HERE I

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YR. VE MA STYLE IF PLACARDED HAZARDOUS
2 MATERIAL HERE . 

VEHICLE LICENSE N0. TRAILER TAG NO. TATE YEAR TAG EXPIRES IF COMPANION CITATIOMSI
HERE

UPON A PUBLIC STREET 0R HJGH WAY OR OTHER LOCATION NAM LY

5/8010?? I M511. MAL

 

 

 

 

 

 

 

 

 

 

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Fl'. MILES OF NODE

DID UNLAWFULLY COMMIT THE FOLLOWING OFFENSE. CHECK ONLY ONE OFFENSE EACH CITATION.
UNLAWFUL SPEED MPH SPEED APPLICABLE MPH

(El INTERSTATE 4-LANE HWY WITH 20 Fr. MEDIAN OUTSIDE BUS. OR RES. DIST.)

CI CARELESS DRIVING El SAFETY BELT VIOLATION CI EXPIRED DRIVER LICENSE
El VIOLATION OF TRAFFIC CONTROL DEVICE IMPROPER 0R UNSAFE EQUIPMENT El FOUR (4) MONTHS OR LESS
VIOLATION OF RIGHT-OF-WAY EXPIRED TAG CI MORE THAN FOUR (4) MONTHS
IMPROPER CHANGE OF LANE OR COURSE SIX (6) MONTHS OR LESS El N0 VALID DRIVER LICENSE
CI IMPROPER PASSING MORE THAN SIX (6) MONTHS DRIVING WHILE LICENSE
CHILD RESTRAINT N0 PROOF OF INSURANCE SIGNAL

DRIVING UNDER THE INFLUENCE OF ALCOHOLIC BEVERAGES. CHEMICAL OR CONTROLLED SUBSTANCES. PHYSICAL CONTROL
WHILE IMPAIRED, OR PHYSICAL CONTROL WITH UNLAWFUL ALCOHOL LEVEL. BAL

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OTHER VIOLATIONS PE AIN FFENS 'Wh?
'v

SUB-SECTION
AGGRESSIVE DRIVING IN VIOLATION OF STATE STATUTE 3 60;

CRASH PROPERTY DAMAGE INJURY TO ANOTHER SERIOUS BODILY INJURY TO ANOTHER FATAL
YES NO YES NO YES NO YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CRIMINAL VIOLATION. COURT APPEARANCE REQUIRED. AS INDICATED BELOW.

INFRACTION. COURT APPEARANCE REQUIRED. AS INDICATED BELOW 9 2 6 CHECK 7
WHICH DOES NOT FIE SPEARA CE COURT. "1 (5 r) DIGIT
URT INFORMATION qu

TIME 

 

COURT

 

LOCATION

 

   
 

DATE
CTIONS SPECIFIED IN THIS CITATION. WILLFUL REFUSAL TO ACCEPT AND SIGN
ADMISSION 0F GUILT OR WAIV RIGHTS. IF YOU NEED REASONABLE FACILITY

    

 

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RANK- SIGNATURE OF OFFICER
HSMV 75901 (FIBV. 02/05)

 

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