Uniform Traffic Ticket
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1Uniform Traffic Ticket
The Accused must appear in court for misdemeanors
Police Agency:
Ticket No.
and felonies.
Circuit Court:
Court Location:
If pleading Guilty, fill out Form A. If pleading Not
Description of Accused
Last Name
First Name
MI
DOB
Age
Guilty, fill out Form B.
Address
City
ST
If your plea is denied, the Courts will send you a
notice in the mail informing you of your mandatory
Sex
Hght
Wght
Race
Hair
Eyes
License No.
Class
court date.
The Accused Listed Above Did Unlawfully:
Form A – Guilty Plea
Description of Violation
Date:
Time:
AM
PM
I,
, the accused, verify that I was charged
In Violation of:
with the violation indicated on the reverse of this ticket. I hereby waive my
Detection Method:
right to an attorney, an arraignment, and a trial. I request that the court
Posted Speed Limit:
decree a fine or penalty that I will pay via mail.
Arrest
Citation
Warning
Infraction
Misdemeanor
Felony
Location of Offense
Hwy No.
Signature
Date
Officer
Affirmed Under
Name:
Penalty of Perjury
Badge:
Form B – Not Guilty Plea
(Name and Signature)
Rank:
I,
, was not issued a supporting deposition
County:
at the time of my citation for the violation indicated on the reverse of this
Date Affirmed:
ticket. I request a supporting deposition, sent to the address listed on the
A Hearing is Scheduled For:
reverse of this ticket.
Court Address
Date:
Time:
AM
PM
Mail in fine by the date listed above
OR
Must appear in person
Signature
Date
Fine
Charge(s)
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