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summons_complaint_penalty_assessment_sheet_fillable_form.pdf
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The People of State, City of Mersonville vs

Vehicle Information

You are hereby directed to appear as indicated

Charges

Mersonville Municipal Court Morris County Court

Traffic Non-Traffic Other

Yes No State Race Sex HGT WGT Hair Eyes Alias

1800900

Yes No

Yes

Yes

No Yes No

Home Phone Cell Phone Work Phone Occupation Employer

X X

Officer:________________ Served by: _______________ Complaining Witness ______________

Residential Address

Drivers’ License Number Presented

Zip CodeStateCity

Identifying Marks/Scars/Tattoos Place of Birth

Mersonville Police Department Summons and Complaint Penalty Assessment

Summons Case Number

First Middle Last DOB

License Plate Number

City/State Statute Number Title

Description

Fine Surcharge Points

City/State Statute Number Title Fine Surcharge Points

Vehicle Year State License Year EvidenceLast Four of Vehicle Identification Number

Make Model Body StyleDamage Color(s) Traffic Crash

Towed Towed Towed By: Towed To:

No

Photos

Felony

Misdemeanor

Description

Approximate Location of Violation Violation Date Violation Time

Felony

Misdemeanor

Morris County Court located at: Street Address, City, State, Zip

Mersonville Municipal Court located at: Street Address, City, State, Zip

To answer charges of violations of the 1970 CRS as Amended

On the day of 20 at AM/PM

Custody/Service Location Service Date Service Time

Non Payable Summons Traffic Criminal

Defendant Held in Custody Morris County Justice Center Defendant Released

Payable Summons Traffic Criminal

The undersigned have probable cause to believe that the defendant committed the offense(s) against the peace and dignity of the people of the State of Colorado; and that this summons and complaint was signed and served upon the defendant at the location and on the date referenced above

Upon signing below I promise to pay the assessed fine within 20 days to the County Treasurer’s Office per the instructions on the reverse side. Further, upon payment of this Penalty Assessment I acknowledge guilt of all charges. I am aware that the Penalty Assessment must be paid within 20 days or it becomes by law a Summons and Complaint and REQUIRES my appearance before the court at the time and place indicated above.

Without admitting guilt, I hereby promise to appear at the time and place indicated. Failure to appear constitutes a separate offense and will result in a warrant being issued.

The Code of Mersonville 2014

Copyright © 2017 Pearson Education, Inc. or its affiliates. All Rights Reserved.

  1. Morris County Court: Off
  2. Non-Traffic: Off
  3. Other: Off
  4. Last:
  5. Middle:
  6. First:
  7. DOB:
  8. City:
  9. Zip Code:
  10. Mersonville Municipal Court: Off
  11. Race:
  12. Sex:
  13. HGT:
  14. WGT:
  15. Hair:
  16. Eyes:
  17. State_2:
  18. Alias:
  19. Work Phone:
  20. Occupation:
  21. Employer:
  22. Residential Address:
  23. Identifying Marks/Scars/Tattoos:
  24. Place of Birth:
  25. Home Phone:
  26. Vehicle Year:
  27. State:
  28. License Year:
  29. Last Four of Vehicle Identification Number:
  30. Make:
  31. Body Style:
  32. Damage:
  33. Color(s):
  34. License Plate Number:
  35. Towed To:
  36. Model:
  37. Towed By:
  38. City/State Statute Number:
  39. Title:
  40. Fine:
  41. Surcharge:
  42. Points:
  43. City/State Statute Number_2:
  44. Title_2:
  45. Fine_2:
  46. Surcharge_2:
  47. Points_2:
  48. Description_2:
  49. Description:
  50. Approximate Location of Violation:
  51. Violation Date:
  52. Violation Time:
  53. Service Date:
  54. Service Time:
  55. Custody/Service Location:
  56. Morris County Court located at: Street Address, City, State, Zip: Off
  57. Mersonville Municipal Court located at: Street Address, City, State, Zip: Off
  58. Street Address, City, State, Zip_2:
  59. Street Address, City, State, Zip:
  60. Non Payable Summons: Off
  61. Traffic: Off
  62. Criminal: Off
  63. Traffic_2: Off
  64. Criminal_2: Off
  65. day:
  66. YY:
  67. Month:
  68. AM/PM:
  69. Signature:
  70. Signature_2:
  71. Cell Phone:
  72. Officer:
  73. Served by:
  74. Complaining Witness:
  75. Traffic_1: Off
  76. Case Number:
  77. State_1:
  78. Felony_4: Off
  79. Felony_3: Off
  80. Payable Summons_1: Off
  81. Payable Summons_2: Off
  82. Payable Summons_3: Off
  83. Payable Summons_4: Off
  84. Yes No: Off
  85. Yes No_2: Off
  86. Yes No_3: Off
  87. Yes No_4: Off
  88. Yes No_5: Off
  89. Felony Misdemeanor: Off
  90. Felony Misdemeanor_2: Off