I am at least 18 years of age, not a party to this action, and I am a resident of or employed in the county where 
where the mailing took place. My business address is: 

On (date): 
, I served this Notice of Correction on the parties at the address listed below by 
depositing in a sealed envelope, postage prepaid, with the United States Postal Service at (city and state): 

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. 

 

Date: 
Original to court 

(Type or print name) 

_______________________________ 
    (SIGNATURE) 

Defendant’s Address:   

PEOPLE OF THE STATE OF CALIFORNIA   
vs. 

(Signature of officer)   

NOTICE OF CORRECTION AND PROOF OF SERVICE 
(Vehicle Code, § 40505) 

AMENDING OFFICER NAME/ID NO.: 
 

DEPARTMENT/AGENCY: 
 

CITATION NUMBER:   
 

CASE NUMBER: 
 

1. A Notice to Appear/Notice to Correct Violation was issued to 

you by an officer of this department on (date):   

2. The citation issued to you contained an error as indicated by 
the items checked below. This notice of correction does not 
affect the validity of the citation or the required court 
appearance.   

Date/time of violation should be ________________ 

Date/time of court appearance should be changed 

from    ____________________    to __________________ 

Violation section(s) should be changed   

from    ____________________    to __________________ 

Location of violation should be changed 

from    ____________________    to __________________ 

Other (specify): 

 declare under penalty of perjury under the laws of the State of 
California that the foregoing is true and correct.   

orm Adopted for Mandatory Use   
Judicial Council of California   
TR-100 [Rev. January 1, 2004] 

ate:   

  I

  D

  F

      NAME OF COURT: 

  STREET ADDRESS: 

  MAILING ADDRESS: 

CITY AND ZIP CODE:   

          BRANCH NAME:   

                TELEPHONE:   

DEFENDANT: