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<br /> M[�Sp)(Ipig)� S?ATE OF MINNESOTA � HC�56�f��/8�) �TATE OF MINNESOTA
<br /> UNIFORM CITATION NO. COUNTY OF HENNEVIN • UNIPORM CRATION NO. COUNTY Of HENNEPIN
<br /> � 018TIIICT COUNT � DISTpICT COURT .
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<br /> ... Tl�e issulnp oNipr states Mat Ih�psraon namW � •:':• .. TM fasulnq ollicer statp t�at IM person nam�0
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<br /> ........ �hssec�ion IndltriW. . ........ �M sec�bn inditate0.
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<br /> � DRIVER'SLICENSENUMBER STATE � ORIVER'SLICENSENUMBER STATE
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<br /> � NAME—LAST,FIRST,MIDDLEIMAIDEN
<br /> I NAME—UST,FIRST,MIDOLE/MAIDEN
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<br /> . ADORE556CITV � ADDqESSaCITY
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<br /> OATEOFB�RiM EYES MEIGNT � WEIGNT SEX ' OATEOFBIRTH EYES HEIGHT WE�GHT SE%
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<br /> YIOIATION INF011MATION i WOLATION INFORNATION
<br /> DATEOf OFFENSE TIME METERNUMBER . OATEOFOFFENSE TIME METERNUMBER
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<br /> VEHICLE LICENSE PUTE STATE VEAR AKE MODEL VEHICIE LICENSE PLATE STATE EAR MAKE MODEL
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<br /> COLOR IOCATION Q CITY COLOR LOCATION d CIT►
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<br /> STAtUTE OF ORDINANCE NO. OESCMPTION � STATUT � INANCE NO. DESCRIPTION
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<br /> < �ENDA ER LIFE ACCIOENT � UNSAFE � � �ENDANGER LIFE �ACCIDENT � UNSAFE
<br /> $ OR PROPERTY CONDITIONS o OR PROPERTY CONDITIONS
<br /> � ADG N BER ORINUMBEH . I Y BAOG NUM ORINVMBER
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<br /> I apree to respond to�is citation and understand that if I fail to do so within 7 days,increased � I agree to respond to this citation and underoland that if I fail lo do so within 7 days,increased
<br /> penalties will W assessed and a warrant will bs issued for my arrest.lf a warrant is isaued,a � penalties will De assessed and a warrant will be isswd lor my arrest.If a wattant{s issued,a
<br /> panalty ot=30 will be added to the flne. penally of S30 will be added lo lAe flne.
<br /> OEFENDANTS SIGNATURE DEFENOANT'S SIGNATURE
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<br /> COURT COPY-DO NOT WRITE ON REVERSE COURT COPY-�O NOT WRITE ON REVERSE
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