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<br /> UNIFORM CITATION NO. COUNTY OF HENNEPIN ; COUNTY OF HENNED{N _
<br /> . DISTRICT COURT � _ UNIFOHbI CITATION NO. DiSrpiCT cout+i
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<br /> DiiiVER�S LiCENSE NUMBER STATE pRIVER'S UCENSE NUMBEH STATE
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<br /> NAME—LAST,FIRST,MIDOIEIMAIDEN � NAME—LAST,FIRST,MIOOLFJMAIDEN
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<br /> ADDRESS 6 CITY � ADDRESS 6 CITY �
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<br /> DnTE OF B�PTM EYES HEIGHT WEIGNT SEX . OATEOF 81RTH EYES HE16HT WEIGHT SEX �
<br /> MO. ' DAY � YEAR I � i � . i �� . . � MO. DAY � YEAR i � I ' � .
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<br /> VIOIATIONINGORMATION � � VIOLATIONINFORMATION
<br /> DATEOFOFFENSE TIME METERNUMBER OATEOFOFFENSE TIME METERNUMBER
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<br /> VENICLEIICENSEPLATE STATE YEAH MAKE MODEL � VEHICIELICENSEPLATE STATE YEAR MAKE MODEL
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<br /> COLOR LOCATION 6 CITY � CA�OR IOCATION d CITY �
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<br /> ORDINANCENO. OESCRIPTION � CiAiYi66fiORDINANCENO. DESCRIPTION"• -
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<br /> �j � � `i ComCoCa CT. tl. ACTIVITY � �� � CpmC e CT.DIV. ACTIVITY
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<br /> 6 � ENDANGER LIFE �ACCIDENT � UNSAFE � a ENDANGER LIFE � UNSAFE
<br /> OR PROPERTY CONDITIONS r o � OR PROPERTY ❑ACCIDENT CONDITIONS
<br /> B�DGENUMBER ORINUMBER i y BA ENUMBEH ORINUMBER �
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<br /> � � � MINI� !ZI I IJbI 'V� I I � I I I MIN � I I ( � �� I � I
<br /> t agree to respond to this citation and understand that it 1 fall to do so wlthln 7 days,Increased ( �agree to respond to►hIs Gtation and undarsiand that H I fail to do so withln 7 days,increased
<br /> penailies wiii be assessed and a warrant will be issued for my arrest.11 a warrant Is Issued,a � penaldes will be assessed and a warrant wlll be Issued(or my anest.If a warrant Is issued,a
<br /> pena�ly ol b30 will be aCaed to the(tne. �� penalty of 830 wlll be added to the Hne.
<br /> DEFENDANT'SSiGNATURE �� DEfENDANTS IGNATURE
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<br /> COURT COPY-DO NOT WRITE ON REVERSE COURT COPY-DO NOT WRITE ON REVERSE
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