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Here is the text we could read:

   

 

tate of Alabama 

Unified Judicial System 

orm UTTC-19  Rev. 8/09 

COURT REPORT 
 
TO THE DEPARTMENT OF PUBLIC SAFETY, STATE OF ALABAMA, OF A CONVICTION OR ADJUDICATION 

REQUIRING SUSPENSION OR REVOCATION OF DRIVERS LICENSE WHERE NO UTTC HAS BEEN ISSUED 

This Report Contains Confidential Information on a Juvenile or Youthful Offender           YES          NO 

OFFENSE DATE 

ear 

  Y

ay 

  D

onth 

  M

 

COURT  ORI  NUMBER 

L                                                J 

  A

 

 

CO 

 

CITY 

 

 

 

 

LABAMA, COUNTY OF 

  A

ASE NUMBER 

AME:   First                              Middle/Maiden                                  Last 

LASS 

  C

DRIVER’S LICENSE NUMBER 

 

ATE OF BIRTH 

 

 

  D

 

ACE 

  R

EX 

 

 

 

 

 

 

 

    -

 

    -

     

TATE 

 

 

  S

 

  S

 

 

 

 

 

 

ELEPHONE NUMBER 

        ) -   

 

 

  T

  (

  C

ays 

  D

 

JAIL TERM 

onths 

  M

ears 

  Y

 

 

COSTS 

 

 

TOTAL 

OMMERCIAL MOTOR VEHICLE         Yes          No                                                              HAZARDOUS MATERIAL INVOLVED       Yes        No 

ASSENGER VEHICLE (requiring passenger endorsement)       Yes       No                                                           CDL REQUIRED        Yes        No 

ODE SECTION / MUNICIPAL ORDINANCE VIOLATED  

  C

      CIRCUIT       DISTRICT       MUNICIPAL         JUVENILE COURT OF 

FINE 

ear 

  Y

 

DATE 

ay 

  D

onth 

  M

 

ONVICTED / ADJUDICATED  

OF 

treet Address 

ity                                                 State                                        Zip 

OURT ORDERED SUSPENSION __________________ MONTHS  

__________________________                                                    ____________________________________ 

Date of Report                                                                                  Judge/Clerk Signature 
 

NPATIENT TREATMENT ORDERED         Yes           No    

ICENSE DESTROYED (DATE) _____/_______/________      ISSUANCE DATE ______/______/_______       ISSUANCE NUMBER _____ 

ISTRIBUTION: 

Part 1 - DPS Reporting Copy 

 HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT ABSTRACT OF THE RECORD OF 
CONVICTION OF SAID PERSON IN THIS COURT. 

  I

    _

Part 2 - Court Record Copy 

License Attached         Yes        No 

ity                                                                       State                                                Zip 

SOCIAL SECURITY NUMBER 

FFENSE CHARGED 

  O

LACE OF OFFENSE                      City and/or County 

lias, If Known 

treet Address 

  S

  F

  C

  N

     

  A

  S

   

  C

  P

   

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  P

   

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Court Report

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Alabama state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from eforms.alacourt.gov (2023-03)
Page(s): 1
Fields(s): 82
Average fields per page: 82
Reading Level: Grade 10
LIST Grouping(s): GO-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Court Report

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02