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NONTRAFFIC NOTICE TO APPEAR 
(Face of Court’s Copy) 

 
 

 

Citation No.) 

  (

Case No. 

                 MISDEMEANOR 
 Nontraffic 

 AM 
 PM 

Day of Week 
S M T W T F S 

Name of Agency and Jurisdiction) 
NOTICE TO APPEAR 
Date of  Violation 
1.          /            / 
Name (First, Middle, Last) 
2. 

Time 

State/Country 

ZIP Code           E-mail Address 

State 

Class 

Age 

Birth Date 
     /      / 

 Juvenile (Phone No.) 
 
(         )

Hair 

Eyes 

Height 

Weight 

Race 

Other Description 

Code 

                   Ordinance                    Description 

 

 

 

 

Misdemeanor or 

Infraction (Circle) 

 

 

 

 

 

 

 

 

 

 

 

         

 
 

DEFENDANT COPY 

SEE REVERSE 
TR-120 

 

  _

  _

  _

  _

 23.___/___/___        ___________________________________________ 
        Dec. Date                            Arresting or Citing Officer 

__________ 

____to_____ 

Serial No. 

    Dates Off 

ime: __________  AM  PM 
Time: __________  AM  PM 

 24.___/___/___    
     Dec. Date 

___________________________________________ 
Name of Arresting Officer, if different from Citing Officer 

__________ 

____to_____ 

Serial No. 

    Dates Off 

  T

WITHOUT ADMITTING GUILT, I PROMISE TO APPEAR AT THE TIME AND PLACE 
INDICATED BELOW. 
X Signature 
 
 26.                WHEN: 

N OR BEFORE THIS DATE: _____/_____/_____  

  O

 25. 

   

 

  _

  Violations not committed in my presence, declared on information and belief. 

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

WHAT TO DO: 
 27.             WHERE: 

FOLLOW THE INSTRUCTIONS ON THE REVERSE. 
[Name of court[s]] 
[Section[s] or division[s], room no[s].] 
[Street address[es]] 
[Phone No.] 

 28.  To be notified 

 You may arrange with the clerk to appear at a night session of the court. 

   

FPO Barcode (USS Code 39) 

 

Evidence Seized  

 

 

Booking Required  

Location of Violation(s) 

City/County of Occurrence 

 

Comments 

Shaded areas on the form indicate spaces subject 
 to modification for local or agency requirements.  
 

Judicial Council of California Form 
Rev. 06-26-15 (Pen. Code, § 853.9)  

   

 

  (

 

 

   

   

   

  7. 
 
  8. 

  9. 
 
10. 

11. 
 
12. 
 
13. 
 
14. 
 
15. 

6. 

7. 

8. 

  1

  1

  1

  19. 

 20. 

 21. 

 22. 

  

 

Address 
3. 

City 
 4. 

Driver Lic. No. 
 5. 

Sex 
 6. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NONTRAFFIC NOTICE TO APPEAR 
(Reverse Of Defendant’s Copy) 

 

 

     

IMPORTANT — READ CAREFULLY 

LOCAL INFORMATION FOR THE CITATION IS AVAILABLE ONLINE 
AT [website address] 
WARNING:  If you fail to appear in court as you have promised, you may be arrested and punished 
by  6  MONTHS  IN JAIL AND/OR A $1,000 FINE, regardless of the disposition of the original charge.  
(Pen. Code, § 853.7.)   

f “Booking Required is checked you must appear on a weekday prior to your court date for booking  
at:  ___________________________________________________ between the hours of ___ and ___ 
and bring the signed verification to your court appearance. Call ____________ for more information. 
Booking Verification: I declare under penalty of perjury under the laws of the State of California that 

____________________________ was booked on _______  ___________________  ___________ 
            Defendant’s name                                                  Date                    Officer                   Serial No. 
 

  I

  _

   

 

 

     

WHAT TO DO 

 

 

 

 

Shaded areas on the form indicate spaces subject 
      to modification for local or agency requirements.  

        

 

        

 

   

 

 

   

 

NONTRAFFIC NOTICE TO APPEAR 
(Reverse Of Court’s Copy) 

 

 

 

 

 

 

         

 

   

(Circle one) 
 
RIGHT or LEFT 
THUMB PRINT 

 

 

 

 

 

 

 

  

     

       

Shaded areas on the form indicate spaces subject 
to modification for local or agency requirements.