D OBLIGATIONS

'a Jl-OGE Hl
STEL I\l TPvl

app opr
In 1"T"t:'rv~ 34 G
he Total Ou Ib

b It;! udgl nd !J0S' \; Sl "I olla era

c Apf' )r~ _ f' c,,, At yO ~ I' ,or v p y

as spucified o~ ,,1e traff" vII I

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ana

3.

Court Office Identified In ITEM 3 on the

INSTRUCTIONS FOR RESPONSE BY MAIL

If you Intend to respond by mall.
1. Detach and complete the lower portion of this traffic citation/summons With your signature on the appropriate
plea line (a. or b.).
2. If you PLEAD NOT GUILTY. your check or money order for collateral must be in the amount reported as Total
Due in ITEM 34. as specified on the reverse side. plus $7.00 costs. If the Total Due IS not specified, your check
or money order for collateral must be in the amount of $50.00. You will be notified by mail of your trial date,
3. If you PLEAD GUILTY, enclose a check or money order in the amount reported as Total Due as specified on
the traffic citation/summons. Failure to remit the full amount reported in ITEM 34 as Total Due may result in the
issuance of a warrant for your arrest.

., ..,

E.M.S. Emergency Medical Services Act.

Explanation of blocks 30, 31, & 33 MCARE Medical Care Availability and ReductiOn of Error Fund,
{
J.C.P./A.T.J. Judicial Computer Project/Access to Justice.

'The lASe. ot !-J"e""(9h~ y fo/ +ha P-t/~se crrl-<ir):dQ"'s.1N1-~~f4,

IS lfIot G1l1V1e./fZ,. p~,~] f.id5~ 1:::M.f- 0 .r:..n:JA
COI\1~ "'9 c:r:- h fIVIe~1 Yjr cJI1,(,
MAIL IN PORTION
+~e s~bJ,:c. o.-\d i"..JiV:'in~q/~C00;~t,r:;J,frf:-~y~~v'IJe;::/v~
~ n,.." Co r1 Z4 \'\1~alrr5 e b'T~Q-1n rEN,.J. [)n Jtle reversjl>!Jd~
I understand the nolice ana::myrig~ts1(n~obliga1rtl~1'I6r, ~f~t<flQ4ll)~krlf:i~
," 1~ •
pfel!: Im~yl.
voluntarily, and intelligently. Failure to Indicate a plea when forwarding an amour{t elfual to the Total Due as
specified on the traffic citation/summons will result in a guilty plea being recorded.

a. I plead NOT GUILTY and request a trial _

Signature

b. I plead GUILTY _
Signature

PLEASE PLACE THE CITATION NUMBER

ON YOUR CHECK OR MONEY ORDER.

DO NOT SEND CASH!