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� HC�307I10/B7I - STATkOFI111NNlSOIN - "'�•A*ir����� . . ` . � . � -'
<br /> COUNiY OF MENNEPIN � UNIFORM CITAT�N NO. COUNT'OF MENNE9IN
<br /> UNIfOHM CITATtON NO. O�STa�Ci COUni � - DRiniCt COueT � -
<br /> QQ 7M bsuMp OMitw sWa IPat tM penon nanr0 Ths iseuiop oftipr States UW IM qnOn wna0 ;.
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<br /> DHIVER'S LICENSE NUMBER STATE - DRIVER'S LICENSE NUMBER STATE
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<br /> NAME—UST,FIHST,MIDDLEIMAIDEN NAME—tA3T,FIRST,MIDOLFJMAIDEN
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<br /> j ADORESS 8 CtTY
<br /> ADOHESS 6 CITY �
<br /> 3 S� `� L � !I � , �' I IJ � I I I I ; � I ( ��� I ' STATE Z�PCODE
<br /> STATE 21PCODE � : ' 1
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<br /> OATE Of BIRTM EYES MEIGHT �� WEIGHT ��SEX � • EYES HEIGHT WEIGMT SEX
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<br /> , VIOLATION INFONMATION � VIO�ATION INFONMATION
<br /> . _ DATEOFOFPENSE TIME METERNUMBER . I DATEOFOFFENSE TIME ME7ERNUMBEF
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<br /> VEMICLELICENSEPLATE STATE YEAR MAKE 'MODEL VEHICLELICENSEPLATE STATE VEAR MAKE MODEL
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<br /> COLOR IOCATION d CIT' COLON � LOCATION 8 CITY
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<br /> STATUTE OR OFO�NANCE N0. DESCRIPTION � � STATUTE OR ORDINANCE NO. OESCR�PTION
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<br /> a . : • . Q I I . � ComCoAe CT.DIV. ACTIVITV
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<br /> < �ENDANGER LIFE �fACCiDENT � UNSAFE � < �ENDANGER LIFE �ACCIDENT � UNSAFE
<br /> � OR PROPERTY CONDITIONS '; o OR PROPERTY CONDITIONS
<br /> BADGENUMBER ORINUMBER i BADGENUMBER ORINUMBER
<br /> � Sg I M'� N � �Zi �� I � G I� j � � � � i � �� �! N v I �� O '
<br /> 1 apree to respond to this citation and understand that ff I falt to do so wllhin 7 days,increased I I aqree to rospond to lhis citation and understand tAat if I tail lo do ao wit�in 7 days,increased
<br /> penalties will be assessed and a warrant will bs�ssued for my arrest.If a warcant la issued,a penaltfea will be assessed and a warrant will be issued tor my arrest.If a warrant is issued,a
<br /> penalty of S30 will be added to the fine. i penalty of S30 will be added to the fine.
<br /> DEFENDANT'S SIGNATURE DEFENDANTS SiGNATURE
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<br /> COURT COPY-DO NOT WRITE ON REVERS'E COURT COPY-DO NOT WRITE ON REVERSE
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