Here is the text we could read:
SAMPLE NONCRIMINAL MUNICIPAL CITATION FORM
FOR USE PURSUANT TO G.L. C. 40, § 21D AND C. 40U, § 14
APPROVED BY THE CHIEF JUSTICE OF THE DISTRICT COURT DEPARTMENT
EFFECTIVE MAY 11, 2010
CITY [or TOWN] OF [Name] NOTICE OF VIOLATION
OF CITY ORDINANCE [or TOWN BY-LAW], RULE OR REGULATION
DATE OF NOTICE
NOTICE NO.
CITY, STATE, ZIP CODE
DOB OF OFFENDER
MV OPERATOR LICENSE NO.
MV/MB REGISTRATION NO.
NAME OF OFFENDER
ADDRESS OF OFFENDER
OFFENSE (s)
DATE & TIME OF VIOLATION
LOCATION OF VIOLATION
I HEREBY ACKNOWLEDGE RECEIPT OF THE FOREGOING CITATION
G Unable to obtain signature of offender. Date Mailed _________________
X
THE NONCRIMINAL FINE FOR THIS OFFENSE IS $ _________________.
YOU HAVE THE FOLLOWING ALTERNATIVES IN THIS MATTER:
Options (1), (2) or (3) will operate as a final disposition, with no resulting criminal record.
(1) You may pay the above noncriminal fine, either by appearing in person or
through an authorized agent, or by mailing a check, money order or postal note WITHIN
21 DAYS OF THE DATE OF THIS NOTICE to: [Address of city or town clerk].
(2) You may contest this matter by making a written request for a noncriminal
hearing before a municipal hearing officer WITHIN 21 DAYS OF THE DATE OF THIS
NOTICE to: [Address of city or town clerk or hearing officer]. If that decision is adverse
to you, within 10 days you may request a new hearing before a court magistrate.
(3) You may obtain a review and disposition by mail by mailing your request
WITHIN 21 DAYS OF THE DATE OF THIS NOTICE to the address shown in Option (2)
above. If the disposition by mail is adverse to you, you may subsequently request a
noncriminal hearing before a municipal hearing officer.
(4) If you do not pay the noncriminal fine or request a hearing or a review by mail
within 21 days, or if you do not appear for the hearing or pay any fine determined to be
due, a criminal complaint may be issued against you.
G I elect Option (1) above, confess the violation charged, and enclose payment by
check, money order or postal note in the amount of $ ________________. I have written
the number of this notice on my check, money order or postal note, or enclosed a copy
of this notice.
G I elect Option (2) above and request a noncriminal hearing on this matter. I have
enclosed a copy of this notice and my name and current address.
G I elect Option (3) above and request a review and disposition by mail. I have
enclosed a copy of this notice, along with a signed statement of my objections, and
signed statements from other relevant persons and any other materials I wish to have
considered. I have marked all statements and materials with my name and address, the
number of this notice, and the violation date.
Signature ___________________________________________________________
SIGNATURE OF ENFORCING PERSON
ENFORCING DEPT.
Municipal Notice of Violation (G.L. c. 40
This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts.
To learn more about the project, check out our about page.
Downloads: You can download both the original form (last checked 2023-03)
and the machine-processed form with normalized data fields.
About This Form:
- Sourced from www.mass.gov (2023-03)
- Page(s): 1
- Fields(s): 12
- Average fields per page: 12
- Reading Level: Grade 8
- LIST Grouping(s):
Unknown
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Identified Data Fields:
We have done our best to automaticly identify and name form fields according to our naming conventions.
When possible, we've used names tied to our question library. See e.g., user1_name.
If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.
Here are the fields we could identify.
name_offender was name_of_offender (0.62 conf)address_offender was address_of_offender (0.37 conf)offense was offense__s (0.32 conf)page_field__1 was page_0_field_3 (0.31 conf)date_time_violation was date_time_of_violation (0.44 conf)page_field__2 was page_0_field_5 (0.31 conf)location_violation was location_of_violation (0.38 conf)x was x (0.34 conf)hereby_acknowledge_foregoing was i_hereby_acknowledge_receipt_of_the_foregoing_citation (0.41 conf)options_final_resulting was options__1_2__or__3__will_operate_as_a_final_disposition__with_no_resulting_criminal_record (0.36 conf)written was i_have_written (0.30 conf)users1_signature was signature (1.00 conf)
We've done our best to group similar variables togther to avoid overwhelming the user.
Suggested Screen 0:
name_offenderaddress_offenderhereby_acknowledge_foregoing
Suggested Screen 1:
Suggested Screen 2:
Suggested Screen 3:
date_time_violationlocation_violation
Suggested Screen 4:
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