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(Citation No.)
Fm
To________
Vac. Dates
Fm
o________
Vac. Dates
T
_______
Serial No.
_______
Serial No.
ime: _______ AM PM
Time: _______ AM PM
T
PHOTO
State/Country
ZIP Code
Juvenile (Phone No.)
( )
State/Country
Class
Commercial
Yes No
Age
Birth Date
/ /
Hair
Eyes
Height
Weight
Race
Other Description
State/Country
Reg. Mo/Yr Exp
COMM. VEH.
(VC 15210(b))
HAZ. MAT.
(VC 353)
Same as Driver
Same as Driver
Veh. Lic. No. or VIN State/Country Reg. Mo/Yr Exp.
Yr. of Veh. Make Model Body Style Color Type
School Zone
VC 42010 Safety Zone
VC 42009 Construction Zone
Correctable Violation (VC 40610)
Yes/No
Code and Section Description
Booking Required (see below) Misdemeanor
or Infraction
Overweight
Make
Model
Body Style
Color
Evidence of Financial Responsibility CHP/DOT/PUC/ICC
10.
Registered Owner or Lessee
11.
Address City State/Country ZIP Code
12.
I
3
l
l
l
M
l
l
L
l
lbs
RIGHT / LEFT
THUMB/ FINGER
PRINT
lbs
lbs
lbs
P.F./Max Spd.
Veh. Lmt.
Safe
Radar
City/County of Occurrence
Comments (Weather, Road & Traffic Conditions, Etc.)l Accident
22.
23. Violations not committed in my presence, declared on information and belief.
24. I declare under penalty of perjury under the laws of the State of California that the foregoing is true
and correct.
itation #______________ Violation location ____________ Executed at (place) _________________
25. __/___/__ _________________________________________
Dec. Date Arresting or Citing Officer
_________________________________________
Name of Arresting Officer,
if different from Citing Officer
WITHOUT ADMITTING GUILT, I PROMISE TO APPEAR AT THE TIME AND PLACE
INDICATED BELOW.
28. WHEN:
N OR BEFORE THIS DATE: _____/_____/_____
O
Address
3.
City
4.
Driver Lic. No.
5.
Sex
6.
E-mail Address
7.
Veh. Lic. No. or VIN
8.
Yr. of Veh.
9.
13.
Veh.
2
14.
l
15.
16. (Y/N)
17. (Y/N)
18. (Y/N)
19. (Y/N)
Speed Approx.
20. >
Location of Violation(s)
21. at
_
26.__/___/__
Dec. Date
Signature
X
27.
WHAT TO DO:
29. WHERE:
C
FOLLOW THE INSTRUCTIONS BELOW.
[Name of court[s]]
[Section[s] or division[s], room no[s].]
[Street address[es]]
[Phone No.]
30. To be notified Contact the clerk to appear at a night court session.
DEFENDANT COPY
Judicial Council of California Form
New 06-26-15 (VC 40500(b),
40513(b), 40522, and 40600;
PC 853.9 and 959.1) TR-135
FPO Barcode
(USS Code 39)
Citation No.)
(
MISDEMEANOR
TRAFFIC NONTRAFFIC
Day of Week
Case No.
AM
PM
3Owner’s Responsibility (VC 40001)
NAME OF AGENCY AND JURISDICTION)
NOTICE TO APPEAR
Date of Violation
1. / /
Name (First, Middle, Last)/(Company)
2.
Time
(
ELECTRONIC TRAFFIC/NONTRAFFIC NOTICE TO APPEAR
(Defendant’s Copy)
Shaded areas indicate spaces subject to modification for local or agency requirements.
ELECTRONIC TRAFFIC/NONTRAFFIC NOTICE TO APPEAR
(Continuation of Defendant’s Copy)
Shaded areas indicate conditional fields for use when citing multiple vehicles or violations with a continuation page.
Citation No.)
(
MISDEMEANOR
TRAFFIC NONTRAFFIC
AM
PM
Day of Week
Case No.
3Owner’s Responsibility (VC 40001)
NAME OF AGENCY AND JURISDICTION)
NOTICE TO APPEAR
Date of Violation
1. / /
Name (First, Middle, Last)/(Company)
2.
Time
(
Address
3.
City
4.
Driver Lic. No.
5.
Sex
6.
E-mail Address
7.
State/Country
ZIP Code
Juvenile (Phone No.)
( )
State/Country
Class
Commercial
Yes No
Age
Birth Date
/ /
Hair
Eyes
Height
Weight
Race
Other Description
School Zone
VC 42010 Safety Zone
8.
VC 42009 Construction Zone
Correctable Violation (VC 40610)
Yes/No
Code and Section Description
Booking Required (see below) Misdemeanor
or Infraction
Overweight
I
3
l
l
l
l
l
l
l
l
l
l
l
l
L
L
L
L
L
l
l
l
l
l
M
l
lbs
lbs
lbs
lbs
lbs
lbs
lbs
lbs
lbs
lbs
lbs
Veh. Lic. No. / VIN State/Country Reg. Mo/Yr Exp.
Yr. of Veh. Make Model Body Style Color Type
Veh. Lic. No. / VIN State/Country Reg. Mo/Yr Exp.
Yr. of Veh. Make Model Body Style Color Type
Veh. Lic. No. / VIN State/Country Reg. Mo/Yr Exp.
Yr. of Veh. Make Model Body Style Color Type
Veh. Lic. No. or VIN
21.
lbs
State/Country
Reg. Mo/Yr
Expiration Date
28. Violations not committed in my presence, declared on information and belief.
29. I declare under penalty of perjury under the laws of the State of California that the foregoing is true
and correct.
itation#______________ Violation location ____________ Executed at (place) _________________
(Citation No.)
Fm
To_______
Vac. Dates
Fm
To_______
Vac. Dates
_______
Serial
No.
_______
Serial
No.
WITHOUT ADMITTING GUILT, I PROMISE TO APPEAR AT THE TIME AND PLACE
INDICATED.
0. __/___/__ _________________________________________
Dec. Date Arresting or Citing Officer
_________________________________________
Name of Arresting Officer,
if different from Citing Officer
_
31.__/___/__
Dec. Date
Signature
X
32.
Judicial Council of California Form
New 06-26-15 (VC 40500(b),
40513(b), 40522, and 40600;
PC 853.9 and 959.1) TR-135
FPO Barcode
(USS Code 39)
Location of Violation
9. (Y/N)
10. (Y/N)
11. (Y/N)
12. (Y/N)
13. (Y/N)
14. (Y/N)
15. (Y/N)
16. (Y/N)
17. (Y/N)
18. (Y/N)
19. (Y/N)
20. (Y/N)
3
22.
Veh.
23.
l
24.
Veh.
4
25.
l
26.
Veh.
5
27.
l
C
3
LOCAL INFORMATION FOR THE CITATION IS AVAILABLE ONLINE AT
[website address]
IMPORTANT — READ CAREFULLY
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 provided above in 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). Correct the violation (traffic cases, when applicable).
Appear in court. Request traffic school (traffic cases, when applicable).
Contest the violation. Request trial by written declaration (traffic cases).
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.)
1. 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 as a fee, and you may have to pay other
fees. Contact the court to request traffic school.
. (Correctable violations) If the “Yes” box is checked above, 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.
Section(s)
Violated
CERTIFICATE OF CORRECTION (MUST BE RETURNED TO COURT)
Serial / ID
No.
Signature of Person
Certifying Correction
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—
b. (Trial by written declaration (traffic infractions)) 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.
ooking Verification: I declare under penalty of perjury under the laws of the
State of California that _______________________ was booked on ___________
Defendant’s name Date
fficer_______________________________ Serial / ID No. _________________
B
O
b
c
ELECTRONIC TRAFFIC/NONTRAFFIC NOTICE TO APPEAR
(Defendant’s Instructions)
(Citation No.)
Shaded areas indicate spaces subject to modification for local or agency requirements.
