Here is the text we could read:
State/Country
ZIP Code E-mail Address
State
Class
Commercial
Yes No
Age
Birth Date
/ /
Hair
Eyes
Height
Weight
Race
Juvenile (Phone No.)
( )
COMMERCIAL VEHICLE
(Veh. Code, § 15210(b))
HAZARDOUS MATERIAL
(Veh. Code, § 353)
State Reg. MO/YR
Make
Model
Body Style
Color
Evidence of Financial Responsibility CHP/DOT/PUC/ICC
9.
Address
3.
City
4.
Driver Lic. No.
5.
Sex
6.
Veh. Lic. No. or VIN
7.
Yr. of Veh.
8.
Registered Owner or Lessee
10.
Address
11.
City
12.
Correctable Violation (Veh. Code,
Yes
No
Same as Driver
Same as Driver
ZIP Code
State
§ 40610)
Code and Section Description
Booking Required (see reverse) Misdemeanor or
Infraction (Circle)
I
I
I
I
N
S
M
M
M
M
_
_
Speed Approx.
P.F./Max Spd.
Veh. Lmt.
Safe
Radar
Continuation
Form Issued
Location of Violation(s)
City/County of Occurrence
W E
Comments (Weather, Road & Traffic Conditions) Accident
DEFENDANT COPY
FPO Barcode (USS Code 39)
_
_
I declare under penalty of perjury under the laws of the State of California the foregoing is true and correct.
Executed at (place) Violation Location
21.___/___/__ ___________________________________________
Dec. Date Arresting or Citing Officer
__________
____to_____
Serial No.
Dates Off
___________________________________________
Name of Arresting Officer, if different from Citing Officer
__________
____to_____
Serial No.
Dates Off
ime: __________ AM PM
Time: __________ AM PM
T
WITHOUT ADMITTING GUILT, I PROMISE TO APPEAR AT THE TIME AND PLACE
INDICATED BELOW.
X Signature
24. WHEN:
N OR BEFORE THIS DATE: _____/_____/_____
O
22.___/___/__
Dec. Date
23.
WHAT TO DO:
25. WHERE:
FOLLOW THE INSTRUCTIONS ON THE REVERSE.
[Name of court[s]]
[Section[s] or division[s], room no[s].]
[Street address[es]]
[Phone No.]
26. To be notified
You may arrange with the clerk to appear at a night session of the court.
Judicial Council of California Form
Rev. 06-26-15 (Veh. Code, §§ 40500(b), 40513(b), 40522, 40600; Pen. Code, § 853.9)
SEE REVERSE
TR-130
Violations not committed in my presence, declared on information and belief.
Shaded areas on the form indicate spaces subject
to modification for local or agency requirements.
_
13.
14.
15.
16.
17.
18. at
19.
20.
(
Citation No.)
(
MISDEMEANOR
Traffic Nontraffic
AM
PM
Day of Week
S M T W T F S
Owner’s Responsibility (Veh. Code, § 40001)
Case No.
NAME OF AGENCY AND JURISDICTION)
NOTICE TO APPEAR
Date of Violation
1. / /
Name (First, Middle, Last)
2.
Time
TRAFFIC/NONTRAFFIC NOTICE TO APPEAR
(Face of Court’s Copy)
TRAFFIC/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.
(Veh. Code, § 40508 or Pen. Code, § 853.7.) In addition, any person who fails to appear as provided
by law may be deemed to have elected to have a trial by written declaration (in absentia) pursuant to
Vehicle Code section 40903(a) upon any alleged infraction, as charged by the arresting/citing
officer.
JUVENILE: If you were under age 18 at the time the citation was issued, you must appear in court with
your parent or guardian.
COURTESY NOTICE: A courtesy notice may be mailed to the address shown on your citation, indicating
the required deposit of money (bail) that may be forfeited instead of your appearing in court. If you do not
receive such courtesy notice, you are still required to comply with the items below by the appearance date.
WHAT TO DO
You are required to appear at court for a misdemeanor violation. For all violations, your court
date/time/place are on the front of this notice to appear. Have the citation with you when contacting the
court. In all infraction cases, you must do one or more of the following for each violation:
Pay the fine (bail).
Appear in court.
Contest the violation.
If you do not do one of the above actions, then a “failure to appear” charge will be filed against you (Veh.
Code, § 40508(a)) and your driver license may be withheld, suspended, or revoked. In some courts you
may be charged an amount in addition to the bail amount and the case may be turned over to a collection
agency. (Pen. Code, § 1214.1.)
Correct the violation (traffic cases, when applicable).
Request traffic school (traffic cases, when applicable).
Request trial by written declaration (traffic cases).
If you do NOT contest the violation:
a. (Pay the bail amount) Contact the court for bail information. You will not have to appear in court.
You will be convicted of the violation, and it will appear on your record at the Department of Motor Vehicles
(DMV). A point count may be charged to your DMV record and your insurance may be adversely affected.
. (Traffic school) You may be able to avoid the point count by completing traffic school. You must
pay the bail amount, and you may have to pay other fees. Contact the court to request traffic school.
. (Correctable violations) If the “Yes” box is checked on the front of your ticket, the violation is
correctable. Upon correction of the violation, have a law enforcement officer or an authorized
inspection/installation station agent sign below. (Veh. Code, § 40616.) Registration and driver license
violations may also be certified as corrected at an office of the DMV or by any clerk or deputy clerk of a
court. The violation will be dismissed by the court after PROOF OF CORRECTION and payment of a
transaction fee are presented to the court by mail or in person by the appearance date. Violations of
Vehicle Code section 16028 (automobile liability insurance) will be dismissed only upon (1) your showing
or mailing to the court evidence of financial responsibility valid at the time this notice to appear was
issued, and (2) your payment of a transaction fee.
CERTIFICATE OF CORRECTION (MUST BE RETURNED TO COURT)
Section(s)
Violated
Signature of Person
Certifying Correction
Serial No.
Agency
Date
2. If you contest the violation (select a or b):
a. (Court trial) Send a certified or registered letter postmarked not later than five days prior to the
appearance date or come to the court by the appearance date to request a court trial on a future date when
an officer and any witnesses will be present. You may be required to submit the bail amount.
Go online or call the court for information on going to court without paying bail. —OR—
. (Trial by written declaration (traffic cases)) Send a certified or registered letter postmarked not
later than five days prior to the appearance date or come to the court on or before the appearance date to
request a trial by written declaration. Submit the bail amount. You will be given forms to allow you to
write a statement and to submit other evidence without appearing in court. An officer will also submit a
statement. The judicial officer will consider the evidence and decide the case.
3. Make check/money order payable to Clerk of the Court. Write your citation number and driver license
number on your check or money order. You may pay in person, by mail, or by phone.
4. If “Booking Required” is checked, you must appear for booking on a weekday prior to your court date
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.
Shaded areas on the form indicate spaces subject
to modification for local or agency requirements.
.
1
b
c
b
_
TRAFFIC/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.
