Traffic Notice To Appear Form - Judicial Council Of California
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1
2TRAFFIC NOTICE TO APPEAR
Automated Traffic Enforcement System
(NAME OF AGENCY AND JURISDICTION)
NOTICE TO APPEAR
Automated Traffic Enforcement
(Citation No.)
Date of Violation
Time
AM
Day of Week
Case No.
/
/
PM
S M T W T F S
1.
Name (First, Middle, Last)
2.
Address
3.
City
State
ZIP Code
4.
Driver Lic. No.
State
Class
Commercial
Age
Birth Date
5.
/
/
Yes
No
Sex
Hair
Eyes
Height
Weight
Race
6.
Veh. Lic. No. or VIN
State
7.
COMMERCIAL VEHICLE
(Veh. Code, § 15210(b))
Yr. of Veh.
Make
Model
Body Style
Color
8.
HAZARDOUS MATERIAL
(Veh. Code, § 353)
Registered Owner or Lessee
9.
Address
10.
City
State
ZIP Code
11.
Code and Section
Description
12.
Location of Violation at
City/County of Occurrence
13.
Violation was not committed in my presence. The above is declared on information and belief and is
based on photographic evidence.
I declare under penalty of perjury under the laws of the State of California the foregoing is true and
correct.
ID No.
Date Issued
Declarant
14.
YOU MUST RESPOND TO THE COURT ON OR BEFORE:
WHEN: DATE:_____________________________________
15.
Time: _______
AM
PM
WHAT TO DO: FOLLOW THE INSTRUCTIONS ON THE REVERSE.
Clerk’s Office Hours
WHERE: [Name of court[s]]
16.
[Insert hours clerk’s office
[Section[s] or division[s], room no[s].]
is open.]
[Street address[es]]
[Phone no.
FPO Barcode
DEFENDANT COPY
SEE REVERSE
Judicial Council of California Form
TR-115
Rev. 06-26-15 (Veh. Code, § 40518)
Shaded areas on the form indicate spaces subject
to modification for local or agency requirements.
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