AZ Traffic Schools - Registration: Ticket Information

The following form is designed to help us gather information about you and your citation. Fill in the fields as they appear on your copy of the ARIZONA TRAFFIC TICKET AND COMPLAINT form.

ARIZONA TRAFFIC TICKET AND COMPLAINT

REPORT NUMBER
n/a

COMPLAINT (Citation #)

ACCIDENT INVOLVED

SERIOUS INJURY

FATALITY/DEATH IN ACCIDENT

ENDORSEMENTS
M	H	N	P	T	X	D

DRIVER'S LICENSE NUMBER	STATE (Drivers License State)	CLASS

DEFENDANT	NAME: FIRST	MIDDLE INITIAL	LAST	PHONE
DEFENDANT				( ) -

RESIDENTIAL ADDRESS	CITY	STATE (Your Home Address)	ZIP CODE

SEX	WEIGHT	HEIGHT	EYES	HAIR	ORIGIN	DATE OF BIRTH	RESTRICTIONS
n/a	n/a	n/a	n/a	n/a	n/a		n/a

BUSINESS ADDRESS	CITY	STATE/COUNTRY	ZIP CODE
n/a	n/a	n/a	n/a

THE UNDERSIGNED CERTIFIES THAT:

ON	DATE (MO/DAY/YR)	TIME OF DAY	SPEED	APPROX	POSTED	R&P	SPEED MEASUREMENT DEVICE	DIRECTION OF TRAVEL
ON		n/a	SPEED	n/a	n/a	n/a	n/a	n/a

AT	LOCATION	PRECINCT	COUNTY	STATE OF
AT	n/a	n/a	n/a	ARIZONA

THE DEFENDANT COMMITTED THE FOLLOWING:

SECTION

ARS

VIOLATION

n/a

DOCKET NUMBER	DISPOSITION CODES	DISPOSITION DATE	SANCTION	CRIMINAL	CRIMINAL TRAFFIC
n/a	n/a	n/a	n/a	CIVIL TRAFFIC	PETTY OFFENSE

YOU MUST
APPEAR AT

JUDGE:	n/a
ADDRESS:	n/a
CITY:	n/a

COURT NUMBER

COURT PHONE
n/a

AT THE DATE AND TIME INDICATED		TIME OF DAY
		n/a

COURT EXTENSION DATE (IF YOU HAVE ONE)

*only use this if you have a court extension

COURT EXTENSION GRANTED HOW?

*only use this if you have a court extension

CRIMINAL

Without admitting guilt, I promise to appear as directed herein.

VICTIM?	VICTIM NOTIFIED
I certify upon reasonable grounds, I believe the person named above committed the acts described and I have served a copy of this complaint upon the defendant.
n/a	n/a	n/a	n/a
COMPLAINANT	ID NO.	DISTRICT	AREA

CIVIL

Without admitting responsibility, I acknowledge receipt of this complaint.