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DEFENDANT'S C O P Y (FURNISH T O COURT)

. IOWA UNIFORM CITATION AND COMPLAINT

State of lowa

SftC

County of:_

.Mn-

81.

gmihe
cou ^ m^mxcomzmsmm
vs:.
rt

' .' Name


:'

"tendant, Last
Last
' Defendant,

Address.

# T 7 < % .

~.

First

"Middle

'

Lci.y ^ F v A y ^ - ^ ^ .

..

s< .nA/ a

, c^iS~
p

State
|:_ DL Class. O

DL Fnd A ^ M DL Rest

fc-DOB.

ftece
--'

DUState ID Viewed? Y e s . / '

Ethn. ^
W/B/I/A7U

.
NoD

Sex

H/N/U

AM

fu'i-,The;unders'igned states that on or-about C>2. / >? ./. 2. o/>.


at j P / ^ J^1"p
|:-defendarit did unlawfully:
-> n .
v ,y
.r
}
? v Operate Motor Vehicle/Boat (describe)t?_L^
C Ac? ^ /
^ / [ / ^ g O

f' CDL Req? YesD


:

|: " Reg# ( ^ l L >

M:!

Day

Yr

N o , / -" Pass. End. Req? YesD N o /


? o ( State : L o ^

/ f

Year ? Q I <-/

HazMat End. Req? Y e s D N'o0^:


l is DOT #

'

Upon a public highway at a


fi Located in the county and state aforesaid anddid then and there commit the following-offense:
Ij-'^Traffic > Navigation D Snowmobile/ATV
D Fish-Game - D Parks TobaccoE- / Sched. Violation/Fine

P Criminal Surcharge , ; $_
p*
.

.
:

. C p . Enf. S u r c h a r g e

fe:

"

Court Costs
Total Fine/COStS

/ 7

. D Road work zone

. S
'

b p

. -y "7
} f

'

D Court Appearance Required (805.10)


R e a s

O o

D Non-scheduied viola. "

n :

I I Serious P.l
I I Fatal Accident"'
r j Civil Damage Assessment f j Other

> ( >

Violation.
^i-;-,

Speed"

- - in

I . ' DATA-CODE

' -- -" - 7 h n p S e c

& ^

"2- f t

Fed/Adm. Code

? o W

^_Local O r d /

- -

IA C o d e

' --

'

|^n ,Pri&/(77' Zo/^" ;V "/^v /Uj^K-


a

. V .

Mo.
Day
.Yr.
.Officer's Signature
I.D. No.
Court Date: If you-must appear in court or if you choose to.appear to answer to a charge which does not require an
appearance, report to the above named court on
t

7*_' -

T? i " i H i .
-".

Mo.

Day

Q' y .

/ A M D PM'

Yr.

NOTICE: Providing false identification information is a violation of Section 719.1 A of the Code oMowa and is
punishable as a simple" misdemeanor.
"
'
-
r,,..-

J $

You hereby are given nolice that withina reasonable time but no later than Ihe date scheduled for your initial ' -' if.'."appearance acitation/complaint sworn under oath will be filed with the district court clerk of the county in which the^: ...; ..-^'f
^citation was issued. '
' ^>;.-i''.
t.
*
-,->
''u0^f\'^ ^^^
t

\ My signature below is not a plea of.guilty, but acknowledges all of the following:

'.

f^.v' 1;. I hereby swear and affirm that the information provided by me on this citation is' true under penalty of providing false

information.
_
\
i;i';--2.-' I promise to appear in-said court at said time and place, or I will comply with the provision on the top of the reverse side o f ^
-thecitation.
.
" I /
i
the citation.
, The following applies to simple misdemeanors only:'*
I
/ "7<C"
f f f I ^*-dollars
" 3. I hereby give my unsecured appearance bond in the amount of '
dollj and enter my written appearance. I
. agree that if Mail to.appear, in person-or by counsel to defend against-, the offense charged in this citation.-the court is , i. .
J- -authorized to enter a conviction and Vender judgment against rhe for the amount of my appearance bond in satisfaction of the '
^ penalty and surcharge plus court costs.
-: /

..<
^
r

'

Hip
V

W i ^ ^ S ^ H r ' ': V-"-~"^.'q

s a r

' ^ S i g n l t u r e ^ o f Defendant

' "

Dispatch /
Case #:

COMPLAINT

Law Enforcement Agency -

SAC CITY POLICE DEPARTMENT


City of:

SAC CITY

SAC COUNTY COURTHOUSE 100 NW STATE STREET SUITE 12

TJOSSEM-HINKELDEY

Name

IOWA UNIFORM CITATION AND COMPLAINT

County of: SAC - 81

State of Iowa
In the Court at
VS.

762 TZER 150219 160446 0

Citation #:

Reference #: XXDB1FR

Form 420001E 1/07


PLAINTIFF

Defendant, Last

AVERY

WENDELL

First

Address 3310 230TH ST

DL Class

The undersigned states that on or about


US DOT#

02/19/2015

$20.00

Criminal Surcharge

$7.00

Co. Enf. Surcharge

N/A

Court Costs

$60.00

Total Fine/Costs

$87.00

Court Appearance Required (805.10)


Reason:

Height

Serious P.I.

2000 TAN

Race
50583-0000
6' 02"
Weight

Ethnicity N
Sex MALE

CHEVROL S10
ET -End
CHEV
Pass

PK

CDL NO
HazMat End Req?
Req?
Req?
Located in the county and state aforesaid and did then and there commit the following offense:

IA

State

Upon a public highway at 800 BLOCK NORTH 5TH ST.


Scheduled Violation/Fine

Zip Code

DL Rest. 3KJ

defendant did unlawfully: Operate Motor Vehicle/Boat

Lic. Plate #/REG CZN319

ICC#

State IA

SAC CITY
DL End. NONE

at 4:04 PM

DOB 4/26/1995

Suffix

City

DL State IA

50583
DL/State ID
Viewed?
YES

441AF6801

DL#

Middle

IA

Year 2015

Road Work Zone

Fatal Accident

Non-scheduled Violation

Civil Damage Assessment

Speed

Other

35

Zone

IA Code: 20 15

ICIS Sec #: 321.285-A

ICIS Ord.

Local Ord.

I.D. No. 81-23


Officer's
Signature

in

Fed/Adm Code:

Violation SPEEDING 55 OR < (1 THRU 5 OVER)


Sec #: 321.285

40

NOTICE: Providing false identification information is a violation of Section 719.1A of


the Code of Iowa and is punishable as a simple misdemeanor.

Dated 02/19/2015

You hereby are given notice that within a reasonable time but no later than the date scheduled for your
initial appearance a citation/complaint sworn under oath will be filed with the district court clerk of the
county in which this citation was issued.

Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not
require an appearance, report to the above named court on:
03/23/2015 at
8:30 AM
My signature below is not a plea of guilty, but acknowledges all of the following:
1. I hereby swear and affirm that the information provided by me on this citation is true under penalty of providing false information.

2. I promise to appear in said court at said time and place. I understand that a person who willfully fails to appear in court as specified by this citation may be subject to arrest and/or loss of driving privileges.
3. If a court appearance is not required, I may enter a plea of guilty prior to the designated appearance date by delivery in person, or by agent, or by mail to the court specified by this citation.
The following applies to simple misdemeanors only:

$100.50
4. I hereby give my unsecured appearance bond in the amount of
dollars and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense
charged in this citation, the court is authorized to enter a conviction and render judgment against me for the amount of my appearance bond in satisfaction of the penalty and surcharge plus court cost.

*+762TZER1502191604460+*
Dated

Signature of
Defendant

02/19/2015

I swear that the foregoing complaint is true and correct.

this

19

day of

Agency

Officer's
Signature

SAC CITY POLICE DEPARTMENT

ABSTRACT OF COURT RECORD


COURT NO.

CASE NO.

DOCKET NO.
LICENSE NO.

CASE NO.
STATE:

NO JURY TRIAL or
PROCEEDING

Notary/other

OTHER

762 TZER 150219 160446 0

TESTIMONY - JUDGE'S NOTES: (Other Orders)


Iowa

FILED 02/19/2015 04:39PM


CLERK DISTRICT COURT
SAC COUNTY IOWA

Other
BAIL CASH DEPOSIT
PLEA

VERDICT

GUILTY
NOT GUILTY

GUILTY
NOT GUILTY
Date

DISMISSED

Signature, person giving bail

Driver's License
Recommendation

OTHER DISPOSITION

None

School

Signature, person taking bail

Susp.

Revo

The court Therefore Enters in Following Order This Date


Mo.

FINED $
Incarceration in

SURCHARGE $

, Iowa

SAC CITY - 6717

Notary/other
Signature

Citation #:

FORFEIT BOND

JURY TRIAL

at

MENTZER, BRIAN
FEBRUARY, 2015

Subscribed and sworn to me by

Day

COST $
Days:

Yr.

DATE:

Continued to:

REASON

DATE:

Continued to:

REASON

DATE:

WARRANT ISSUED

TO THE COURT: The following are witnesses who can give testimony relating to the facts of this alleged violation. Please subpoena prosecuting witness:
Name
Address
Phone

Days

Dispatch /
Case #:

COMPLAINT
Form 420001E 1/07
PLAINTIFF

Reference #:

Law Enforcement Agency -

MOTOR VEHICLE ENFORCEMENT


City of:

SAC CITY

SAC COUNTY COURTHOUSE 100 NW STATE STREET SUITE 12

MIENE

Name

IOWA UNIFORM CITATION AND COMPLAINT

County of: SAC - 81

State of Iowa
In the Court at
VS.

T01 T319 150219 125622 0

Citation #:

TRACE

Defendant, Last

HARLAND

First

Address 406 S EGBERT ST

DL Class

The undersigned states that on or about


US DOT# 02049090

02/19/2015

$200.00

Criminal Surcharge

$70.00

Co. Enf. Surcharge

N/A

Court Costs

$60.00

Total Fine/Costs

$330.00

Court Appearance Required (805.10)


Reason:

Height

2015 WHI

Serious P.I.

Race W
52159-0000
6' 03"
Weight

Ethnicity N
Sex MALE

PETERBIL CON
TT-ST
T - PTRB
Pass
End NO
HazMat End Req? NO

CDL YES
Req?
Req?
Located in the county and state aforesaid and did then and there commit the following offense:

IA

State

Upon a public highway at US 71/KARR AVE AND D015/190TH ST


Scheduled Violation/Fine

Zip Code

DL Rest. NONE

defendant did unlawfully: Operate Motor Vehicle/Boat

Lic. Plate #/REG BK7124

ICC#

State IA

MONONA
DL End. NONE

at 12:33 PM

DOB 2/16/1977

Suffix

City

DL State IA

50583
DL/State ID
Viewed?
YES

993AA7064

DL#

Middle

IA

Year 2015

Road Work Zone

Fatal Accident

Non-scheduled Violation

Civil Damage Assessment

Speed

Other

Violation MEDICAL DOWNGRADE CDL IS NO LONGER VALID


Sec #: 321.174

ICIS Sec #: 321.174(1)

Zone

IA Code: 20 13
ICIS Ord.

Local Ord.

I.D. No. T319


Officer's
Signature

in

Fed/Adm Code: 383.23A2

NOTICE: Providing false identification information is a violation of Section 719.1A of


the Code of Iowa and is punishable as a simple misdemeanor.

Dated 02/19/2015

You hereby are given notice that within a reasonable time but no later than the date scheduled for your
initial appearance a citation/complaint sworn under oath will be filed with the district court clerk of the
county in which this citation was issued.

Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not
require an appearance, report to the above named court on:
03/16/2015 at
8:30 AM
My signature below is not a plea of guilty, but acknowledges all of the following:
1. I hereby swear and affirm that the information provided by me on this citation is true under penalty of providing false information.

2. I promise to appear in said court at said time and place. I understand that a person who willfully fails to appear in court as specified by this citation may be subject to arrest and/or loss of driving privileges.
3. If a court appearance is not required, I may enter a plea of guilty prior to the designated appearance date by delivery in person, or by agent, or by mail to the court specified by this citation.
The following applies to simple misdemeanors only:

$465.00
4. I hereby give my unsecured appearance bond in the amount of
dollars and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense
charged in this citation, the court is authorized to enter a conviction and render judgment against me for the amount of my appearance bond in satisfaction of the penalty and surcharge plus court cost.

*+T01T3191502191256220+*
Dated

Signature of
Defendant

02/19/2015

I swear that the foregoing complaint is true and correct.

this

19

day of

Agency

Officer's
Signature

MOTOR VEHICLE ENFORCEMENT

ABSTRACT OF COURT RECORD


COURT NO.

CASE NO.

DOCKET NO.
LICENSE NO.

CASE NO.
STATE:

NO JURY TRIAL or
PROCEEDING

Notary/other

OTHER

T01 T319 150219 125622 0

TESTIMONY - JUDGE'S NOTES: (Other Orders)


Iowa

FILED 02/19/2015 07:30PM


CLERK DISTRICT COURT
SAC COUNTY IOWA

Other
BAIL CASH DEPOSIT
PLEA

VERDICT

GUILTY
NOT GUILTY

GUILTY
NOT GUILTY
Date

DISMISSED

Signature, person giving bail

Driver's License
Recommendation

OTHER DISPOSITION

None

School

Signature, person taking bail

Susp.

Revo

The court Therefore Enters in Following Order This Date


Mo.

FINED $
Incarceration in

SURCHARGE $

, Iowa

EARLY - 2200

Notary/other
Signature

Citation #:

FORFEIT BOND

JURY TRIAL

at

LAAKE, PAUL
FEBRUARY, 2015

Subscribed and sworn to me by

Day

COST $
Days:

Yr.

DATE:

Continued to:

REASON

DATE:

Continued to:

REASON

DATE:

WARRANT ISSUED

TO THE COURT: The following are witnesses who can give testimony relating to the facts of this alleged violation. Please subpoena prosecuting witness:
Name
Address
Phone

Days

Dispatch /
Case #:

COMPLAINT
Form 420001E 1/07
PLAINTIFF

Reference #:

Law Enforcement Agency -

MOTOR VEHICLE ENFORCEMENT


City of:

SAC CITY

SAC COUNTY COURTHOUSE 100 NW STATE STREET SUITE 12

STREETS

Name

IOWA UNIFORM CITATION AND COMPLAINT

County of: SAC - 81

State of Iowa
In the Court at
VS.

T01 T319 150219 114636 8

Citation #:

BRYAN

Defendant, Last

Middle

Address 236 CARTHAGE AVE

02/19/2015

The undersigned states that on or about


US DOT# 01979132

DL Class

ICC# 699676

$40.00
$14.00

Co. Enf. Surcharge

N/A

Court Costs

$60.00

Total Fine/Costs

$114.00

2007 SIL

Serious P.I.

Race W

45215
5' 09"

Ethnicity N

Weight 245 LBS

Sex MALE

CHEVROL
ET -End
CHEV
Pass
NO

TT-ST

CDL YES
HazMat End Req? NO
Req?
Req?
Located in the county and state aforesaid and did then and there commit the following offense:

Court Appearance Required (805.10)


Reason:

Height

OH Year 2015

State

Upon a public highway at US 71/KARR AVE AND D015/190TH ST

Criminal Surcharge

Zip Code

DL Rest. NONE

defendant did unlawfully: Operate Motor Vehicle/Boat

Lic. Plate #/REG PIJ8289

Scheduled Violation/Fine

State OH

CINCINNATI
DL End. A

at 11:38 AM

DOB 9/28/1988

Suffix

City

DL State OH

50583
DL/State ID
Viewed?
YES

TH934386

DL#

First

IA

Road Work Zone

Fatal Accident

Non-scheduled Violation

Civil Damage Assessment

Speed

Other

ICIS Sec #: 321.285-B

55

Zone

IA Code: 20 15
ICIS Ord.

Local Ord.

I.D. No. T319


Officer's
Signature

in

Fed/Adm Code: 392.2-SLLS3

Violation EXCESSIVE SPEED 65 IN POSTD 55MPH ZONE <66>


Sec #: 321.285

65

NOTICE: Providing false identification information is a violation of Section 719.1A of


the Code of Iowa and is punishable as a simple misdemeanor.

Dated 02/19/2015

You hereby are given notice that within a reasonable time but no later than the date scheduled for your
initial appearance a citation/complaint sworn under oath will be filed with the district court clerk of the
county in which this citation was issued.

Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not
require an appearance, report to the above named court on:
03/16/2015 at
8:30 AM
My signature below is not a plea of guilty, but acknowledges all of the following:
1. I hereby swear and affirm that the information provided by me on this citation is true under penalty of providing false information.

2. I promise to appear in said court at said time and place. I understand that a person who willfully fails to appear in court as specified by this citation may be subject to arrest and/or loss of driving privileges.
3. If a court appearance is not required, I may enter a plea of guilty prior to the designated appearance date by delivery in person, or by agent, or by mail to the court specified by this citation.
The following applies to simple misdemeanors only:

$141.00
4. I hereby give my unsecured appearance bond in the amount of
dollars and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense
charged in this citation, the court is authorized to enter a conviction and render judgment against me for the amount of my appearance bond in satisfaction of the penalty and surcharge plus court cost.

*+T01T3191502191146368+*
Dated

Signature of
Defendant

02/19/2015

I swear that the foregoing complaint is true and correct.

this

19

day of

Agency

Officer's
Signature

MOTOR VEHICLE ENFORCEMENT

ABSTRACT OF COURT RECORD


COURT NO.

CASE NO.

DOCKET NO.
LICENSE NO.

CASE NO.
STATE:

NO JURY TRIAL or
PROCEEDING

Notary/other

OTHER

T01 T319 150219 114636 8

TESTIMONY - JUDGE'S NOTES: (Other Orders)


Iowa

FILED 02/19/2015 07:30PM


CLERK DISTRICT COURT
SAC COUNTY IOWA

Other
BAIL CASH DEPOSIT
PLEA

VERDICT

GUILTY
NOT GUILTY

GUILTY
NOT GUILTY
Date

DISMISSED

Signature, person giving bail

Driver's License
Recommendation

OTHER DISPOSITION

None

School

Signature, person taking bail

Susp.

Revo

The court Therefore Enters in Following Order This Date


Mo.

FINED $
Incarceration in

SURCHARGE $

, Iowa

EARLY - 2200

Notary/other
Signature

Citation #:

FORFEIT BOND

JURY TRIAL

at

LAAKE, PAUL
FEBRUARY, 2015

Subscribed and sworn to me by

Day

COST $
Days:

Yr.

DATE:

Continued to:

REASON

DATE:

Continued to:

REASON

DATE:

WARRANT ISSUED

TO THE COURT: The following are witnesses who can give testimony relating to the facts of this alleged violation. Please subpoena prosecuting witness:
Name
Address
Phone

Days

Dispatch /
Case #:

COMPLAINT

Law Enforcement Agency -

MOTOR VEHICLE ENFORCEMENT


City of:

SAC CITY

SAC COUNTY COURTHOUSE 100 NW STATE STREET SUITE 12

PAPLOW

Name

IOWA UNIFORM CITATION AND COMPLAINT

County of: SAC - 81

State of Iowa
In the Court at
VS.

T01 T319 150219 140012 2

Citation #:

Reference #:

Form 420001E 1/07


PLAINTIFF

PAUL

Defendant, Last

DEAN

First

Address 6212 120TH ST

DL Class

02/19/2015

The undersigned states that on or about


US DOT# 01078695

ICC# 448313

$50.00
$17.50

Co. Enf. Surcharge

N/A

Court Costs

$60.00

Total Fine/Costs

$127.50

Serious P.I.

Race W
51354-0000
6' 01"
Weight

2004 WHI

Ethnicity N
Sex MALE

PETERBIL
T - PTRB
Pass
End NO

TT-ST

CDL YES
HazMat End Req? NO
Req?
Req?
Located in the county and state aforesaid and did then and there commit the following offense:

Court Appearance Required (805.10)


Reason:

Height

State MN Year 2014

Upon a public highway at US 71/KARR AVE

Criminal Surcharge

Zip Code

DL Rest. NONE

defendant did unlawfully: Operate Motor Vehicle/Boat

Lic. Plate #/REG PAL6855

Scheduled Violation/Fine

State IA

OCHEYEDAN
DL End. T

at 1:45 PM

DOB 8/9/1983

Suffix

City

DL State IA

50583
DL/State ID
Viewed?
YES

509AG7382

DL#

Middle

IA

Road Work Zone

Fatal Accident

Non-scheduled Violation

Civil Damage Assessment

Speed

Other

Violation LOOSE CHAINS ON DECK OF TRAILER, NOT ATTACHED OR SECURED


Sec #: 321.449

ICIS Sec #: 321.449-A

Zone

IA Code: 20 13
ICIS Ord.

Local Ord.

I.D. No. T319


Officer's
Signature

in

Fed/Adm Code: 393.100B

NOTICE: Providing false identification information is a violation of Section 719.1A of


the Code of Iowa and is punishable as a simple misdemeanor.

Dated 02/19/2015

You hereby are given notice that within a reasonable time but no later than the date scheduled for your
initial appearance a citation/complaint sworn under oath will be filed with the district court clerk of the
county in which this citation was issued.

Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not
require an appearance, report to the above named court on:
03/16/2015 at
8:30 AM
My signature below is not a plea of guilty, but acknowledges all of the following:
1. I hereby swear and affirm that the information provided by me on this citation is true under penalty of providing false information.

2. I promise to appear in said court at said time and place. I understand that a person who willfully fails to appear in court as specified by this citation may be subject to arrest and/or loss of driving privileges.
3. If a court appearance is not required, I may enter a plea of guilty prior to the designated appearance date by delivery in person, or by agent, or by mail to the court specified by this citation.
The following applies to simple misdemeanors only:

$161.25
4. I hereby give my unsecured appearance bond in the amount of
dollars and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense
charged in this citation, the court is authorized to enter a conviction and render judgment against me for the amount of my appearance bond in satisfaction of the penalty and surcharge plus court cost.

*+T01T3191502191400122+*
Dated

Signature of
Defendant

02/19/2015

I swear that the foregoing complaint is true and correct.

this

19

day of

Agency

Officer's
Signature

MOTOR VEHICLE ENFORCEMENT

ABSTRACT OF COURT RECORD


COURT NO.

CASE NO.

DOCKET NO.
LICENSE NO.

CASE NO.
STATE:

NO JURY TRIAL or
PROCEEDING

Notary/other

OTHER

T01 T319 150219 140012 2

TESTIMONY - JUDGE'S NOTES: (Other Orders)


Iowa

FILED 02/19/2015 07:30PM


CLERK DISTRICT COURT
SAC COUNTY IOWA

Other
BAIL CASH DEPOSIT
PLEA

VERDICT

GUILTY
NOT GUILTY

GUILTY
NOT GUILTY
Date

DISMISSED

Signature, person giving bail

Driver's License
Recommendation

OTHER DISPOSITION

None

School

Signature, person taking bail

Susp.

Revo

The court Therefore Enters in Following Order This Date


Mo.

FINED $
Incarceration in

SURCHARGE $

, Iowa

EARLY - 2200

Notary/other
Signature

Citation #:

FORFEIT BOND

JURY TRIAL

at

LAAKE, PAUL
FEBRUARY, 2015

Subscribed and sworn to me by

Day

COST $
Days:

Yr.

DATE:

Continued to:

REASON

DATE:

Continued to:

REASON

DATE:

WARRANT ISSUED

TO THE COURT: The following are witnesses who can give testimony relating to the facts of this alleged violation. Please subpoena prosecuting witness:
Name
Address
Phone

Days

Dispatch /
Case #:

COMPLAINT
Form 420001E 1/07
PLAINTIFF

Reference #:

Law Enforcement Agency -

MOTOR VEHICLE ENFORCEMENT


City of:

SAC CITY

SAC COUNTY COURTHOUSE 100 NW STATE STREET SUITE 12

STARK

Name

IOWA UNIFORM CITATION AND COMPLAINT

County of: SAC - 81

State of Iowa
In the Court at
VS.

T01 T319 150219 142528 4

Citation #:

MICHAEL

Defendant, Last

First

Address 1502 CHOKECHERRY LANE

DL Class

The undersigned states that on or about


US DOT# 00688617

02/19/2015

$250.00

Criminal Surcharge

$87.50

Co. Enf. Surcharge

N/A

Court Costs

$60.00

Total Fine/Costs

$397.50

Court Appearance Required (805.10)


Reason:

Height

2006 WHI

Serious P.I.

Race W
68776-0000
5' 09"
Weight

FORD FORD
Pass
End

Ethnicity N
Sex MALE

CTV

VN

CDL NO
HazMat End Req?
Req?
Req?
Located in the county and state aforesaid and did then and there commit the following offense:

IA

State

Upon a public highway at US 71/KARR AVE


Scheduled Violation/Fine

Zip Code

DL Rest. NONE

defendant did unlawfully: Operate Motor Vehicle/Boat

Lic. Plate #/REG 107YBR

ICC#

State NE

SOUTH SIOUX CITY


DL End. NONE

at 2:10 PM

DOB 8/18/1971

Suffix

City

DL State NE

50583
DL/State ID
Viewed?
YES

G70012288

DL#

Middle

IA

Year 2015

Road Work Zone

Fatal Accident

Non-scheduled Violation

Civil Damage Assessment

Speed

Other

Violation FAIL TO CARRY INSURANCE CARD


Sec #: 321.20B

Zone

IA Code: 20 13

ICIS Sec #: 321.20B-A

ICIS Ord.

Local Ord.

I.D. No. T319


Officer's
Signature

in

Fed/Adm Code: 392.2IN

NOTICE: Providing false identification information is a violation of Section 719.1A of


the Code of Iowa and is punishable as a simple misdemeanor.

Dated 02/19/2015

You hereby are given notice that within a reasonable time but no later than the date scheduled for your
initial appearance a citation/complaint sworn under oath will be filed with the district court clerk of the
county in which this citation was issued.

Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not
require an appearance, report to the above named court on:
03/16/2015 at
8:30 AM
My signature below is not a plea of guilty, but acknowledges all of the following:
1. I hereby swear and affirm that the information provided by me on this citation is true under penalty of providing false information.

2. I promise to appear in said court at said time and place. I understand that a person who willfully fails to appear in court as specified by this citation may be subject to arrest and/or loss of driving privileges.
3. If a court appearance is not required, I may enter a plea of guilty prior to the designated appearance date by delivery in person, or by agent, or by mail to the court specified by this citation.
The following applies to simple misdemeanors only:

$566.25
4. I hereby give my unsecured appearance bond in the amount of
dollars and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense
charged in this citation, the court is authorized to enter a conviction and render judgment against me for the amount of my appearance bond in satisfaction of the penalty and surcharge plus court cost.

*+T01T3191502191425284+*
Dated

Signature of
Defendant

02/19/2015

I swear that the foregoing complaint is true and correct.

this

19

day of

Agency

Officer's
Signature

MOTOR VEHICLE ENFORCEMENT

ABSTRACT OF COURT RECORD


COURT NO.

CASE NO.

DOCKET NO.
LICENSE NO.

CASE NO.
STATE:

NO JURY TRIAL or
PROCEEDING

Notary/other

OTHER

T01 T319 150219 142528 4

TESTIMONY - JUDGE'S NOTES: (Other Orders)


Iowa

FILED 02/19/2015 07:30PM


CLERK DISTRICT COURT
SAC COUNTY IOWA

Other
BAIL CASH DEPOSIT
PLEA

VERDICT

GUILTY
NOT GUILTY

GUILTY
NOT GUILTY
Date

DISMISSED

Signature, person giving bail

Driver's License
Recommendation

OTHER DISPOSITION

None

School

Signature, person taking bail

Susp.

Revo

The court Therefore Enters in Following Order This Date


Mo.

FINED $
Incarceration in

SURCHARGE $

, Iowa

EARLY - 2200

Notary/other
Signature

Citation #:

FORFEIT BOND

JURY TRIAL

at

LAAKE, PAUL
FEBRUARY, 2015

Subscribed and sworn to me by

Day

COST $
Days:

Yr.

DATE:

Continued to:

REASON

DATE:

Continued to:

REASON

DATE:

WARRANT ISSUED

TO THE COURT: The following are witnesses who can give testimony relating to the facts of this alleged violation. Please subpoena prosecuting witness:
Name
Address
Phone

Days

Dispatch /
Case #:

COMPLAINT
Form 420001E 1/07
PLAINTIFF

Reference #:

Law Enforcement Agency -

MOTOR VEHICLE ENFORCEMENT


City of:

SAC CITY

SAC COUNTY COURTHOUSE 100 NW STATE STREET SUITE 12

STARK

Name

IOWA UNIFORM CITATION AND COMPLAINT

County of: SAC - 81

State of Iowa
In the Court at
VS.

T01 T319 150219 142548 5

Citation #:

MICHAEL

Defendant, Last

First

Address 1502 CHOKECHERRY LANE

DL Class

The undersigned states that on or about


US DOT# 00688617

02/19/2015

$50.00

Criminal Surcharge

$17.50

Co. Enf. Surcharge

N/A

Court Costs

$60.00

Total Fine/Costs

$127.50

Court Appearance Required (805.10)


Reason:

Height

2006 WHI

Serious P.I.

Race W
68776-0000
5' 09"
Weight

FORD FORD
Pass
End

Ethnicity N
Sex MALE

CTV

VN

CDL NO
HazMat End Req?
Req?
Req?
Located in the county and state aforesaid and did then and there commit the following offense:

IA

State

Upon a public highway at US 71/KARR AVE


Scheduled Violation/Fine

Zip Code

DL Rest. NONE

defendant did unlawfully: Operate Motor Vehicle/Boat

Lic. Plate #/REG 107YBR

ICC#

State NE

SOUTH SIOUX CITY


DL End. NONE

at 2:10 PM

DOB 8/18/1971

Suffix

City

DL State NE

50583
DL/State ID
Viewed?
YES

G70012288

DL#

Middle

IA

Year 2015

Road Work Zone

Fatal Accident

Non-scheduled Violation

Civil Damage Assessment

Speed

Other

Violation NO PROOF OF CURRENT ANNUAL INSPECTION


Sec #: 321.449

ICIS Sec #: 321.449-A

Zone

IA Code: 20 13
ICIS Ord.

Local Ord.

I.D. No. T319


Officer's
Signature

in

Fed/Adm Code: 396.17C

NOTICE: Providing false identification information is a violation of Section 719.1A of


the Code of Iowa and is punishable as a simple misdemeanor.

Dated 02/19/2015

You hereby are given notice that within a reasonable time but no later than the date scheduled for your
initial appearance a citation/complaint sworn under oath will be filed with the district court clerk of the
county in which this citation was issued.

Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not
require an appearance, report to the above named court on:
03/16/2015 at
8:30 AM
My signature below is not a plea of guilty, but acknowledges all of the following:
1. I hereby swear and affirm that the information provided by me on this citation is true under penalty of providing false information.

2. I promise to appear in said court at said time and place. I understand that a person who willfully fails to appear in court as specified by this citation may be subject to arrest and/or loss of driving privileges.
3. If a court appearance is not required, I may enter a plea of guilty prior to the designated appearance date by delivery in person, or by agent, or by mail to the court specified by this citation.
The following applies to simple misdemeanors only:

$161.25
4. I hereby give my unsecured appearance bond in the amount of
dollars and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense
charged in this citation, the court is authorized to enter a conviction and render judgment against me for the amount of my appearance bond in satisfaction of the penalty and surcharge plus court cost.

*+T01T3191502191425485+*
Dated

Signature of
Defendant

02/19/2015

I swear that the foregoing complaint is true and correct.

this

19

day of

Agency

Officer's
Signature

MOTOR VEHICLE ENFORCEMENT

ABSTRACT OF COURT RECORD


COURT NO.

CASE NO.

DOCKET NO.
LICENSE NO.

CASE NO.
STATE:

NO JURY TRIAL or
PROCEEDING

Notary/other

OTHER

T01 T319 150219 142548 5

TESTIMONY - JUDGE'S NOTES: (Other Orders)


Iowa

FILED 02/19/2015 07:30PM


CLERK DISTRICT COURT
SAC COUNTY IOWA

Other
BAIL CASH DEPOSIT
PLEA

VERDICT

GUILTY
NOT GUILTY

GUILTY
NOT GUILTY
Date

DISMISSED

Signature, person giving bail

Driver's License
Recommendation

OTHER DISPOSITION

None

School

Signature, person taking bail

Susp.

Revo

The court Therefore Enters in Following Order This Date


Mo.

FINED $
Incarceration in

SURCHARGE $

, Iowa

EARLY - 2200

Notary/other
Signature

Citation #:

FORFEIT BOND

JURY TRIAL

at

LAAKE, PAUL
FEBRUARY, 2015

Subscribed and sworn to me by

Day

COST $
Days:

Yr.

DATE:

Continued to:

REASON

DATE:

Continued to:

REASON

DATE:

WARRANT ISSUED

TO THE COURT: The following are witnesses who can give testimony relating to the facts of this alleged violation. Please subpoena prosecuting witness:
Name
Address
Phone

Days