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CONTINUATION OF NOTICE TO APPEAR 
(Face of Violator’s Copy) 

(Citation No.) 

              
                c MISDEMEANOR 
cTraffic   c Nontraffic 

   

AM 
PM 

Day of  Week 
S M T W T F S 

Case No. 

 
 

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

Time 

Veh. Lic. No. or  VIN  
 3.                                                                                                                            
 

 

Correctable Violation (Veh. Code,

§ 40610)

 

 

 

Yes 

 No 

Code   and   Section                  Description 

 

     
 

 

 

 

Misdemeanor or

 

Infraction (Circle) 

State 

    

    

Arresting or Citing Officer 

   Serial No. 

 
SEE REVERSE 
TR-106 

23.            /         / 
               Date                   Name of Arresting Officer, if different from Citing Officer 

   Serial No. 

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

 
Judicial Council of California Form 
Rev. 01-01-04  (Veh. Code, §§ 40500(b), 40513(b), 40522, 40600; Pen. Code, § 853.9) 

   

 

  24. 

1.c  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, and a continuation of the enforcement document noted. 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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CONTINUATION OF NOTICE TO APPEAR 
(REVERSE OF VIOLATOR’S COPY) 

IMPORTANT — READ CAREFULLY 

 
  This form is used when multiple offenses are charged and the original notice to appear form does not 
provide sufficient space for the listing of all the charges.  PLEASE REFER TO THE REVERSE OF THE 
ORIGINAL  NOTICE  TO  APPEAR  FOR  IMPORTANT  INFORMATION  REGARDING  YOUR  LEGAL 
OBLIGATIONS. 

 

  CORRECTABLE  VIOLATIONS:  Those  driver  license,  vehicle  registration,  and  mechanical  violations 
 
cited  in  accordance  with  Vehicle  Code  section  40610(a)  will  be  dismissed  by  the  court  if PROOF OF 
CORRECTION and payment of a transaction fee are presented to the court by mail or in person on or 
before the appearance date.  

iolations of Vehicle Code section 16028 (automobile insurance) will be dismissed upon your showing 

to the court that evidence of financial responsibility was valid at the time this citation was issued.  

roof  of  correction  should  be  obtained  for  driver  license,  registration,  and  equipment  violations.  

CORRECT EQUIPMENT VIOLATIONS IMMEDIATELY.   
 

 

  V

  P

 

METHODS FOR OBTAINING CERTIFICATION OF CORRECTION (Veh. Code, § 40616): 
1. Pollution control device violations must be certified by a smog check station licensed by the 
California Bureau of Automobile Repair.  
2. Lamp, brakes, and exhaust system violations may be certified as corrected by an authorized 
inspection and installation station for the specific violation(s). 
3. Registration and driver license violations may also be certified as corrected by an office of the 
Department of Motor Vehicles or by any clerk or deputy clerk of a court. 
4.  Proof of correction, except for violations that must be cleared at a certified inspection and 
installation station, may be obtained at ____________________________________ (fill in location) 
during regular business hours. 

CERTIFICATE OF CORRECTION (MUST BE RETURNED TO COURT) 

Section(s) 
Violated 
 

Signature of Person 
Certifying Correction 
 

Serial No. 
 

Agency 
 

Date 
 

 

     

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

   

CONTINUATION OF NOTICE TO APEAR 
(Reverse Of Court Copy) 

 

 

 

 

 

 

         

 

   

(Circle one) 
 
RIGHT or LEFT 
THUMB PRINT 

 

 

 

 

 

 

 

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