FILEIMAY 1 4 2014

SUPREME COURTCLERK

ILLINOIS CONFERENCE OF CHIEF CIRCUIT JUDGESAdministrative Office of the Illinois Courts

3101 Old Jacksonville Road 222 . LaSaUe Street, 13h FloorSpringfield, IL 62704Chicago, IL 60601

May 14, 2014

Honorable Carolyn Taft GrosboltClerk of the Supreme CourtSupreme Court BuildingSpringfield, IL 6270 1-1791

Re: Uniform Citation and Complaint Form

Dear Ms. Grosboll:

The Conference of Chief Circuit Judges, at its meeting on April 25, 2014, approved changesto the Uniform Citation and Complaint Form (Uniform Traffic Ticket). The changes approved affectthe CDL indication and vehicle type sections and added a vehicle use section. On behalf of theConference of Chief Circuit Judges, I hereby submit the approved citation form and its printinginstructions to your office for filing pursuant to Supreme Court Rule 552.

The new form and printing instructions are effective immediately and full compliance isrequired by January 1, 2015. Any Uniform Traffic Tickets purchased after this form is filed withyour office must conform to the new form and printing instructions provided herein. Agencieswishing to deplete their current inventory may do so through December 31, 2014.

Sincerely

22

E izabeth A. RobbChairConference of Chief Circuit Judges

Enclosures

C)1Uniforrn Traffic Citation -Vehicle Use_2009-15.Revised Traffic_Citation -Increase Boniqxd 4/3/2014 10:04 AM Page 1

NOTE: USE SEPARATE CITATIONFOR EACH VIOLATION

— 11111 iil kill 11111 11111 kIll iil llll 1101 0 0 0 0 0 0 0DCN I FILED

CASE ISP 01ST.No occ. COMPLAINT MAY 1 4 2014COUNTY TOWNSHIP ppOr Or

RDPEOPLE STATE CITY/VILLAGE Ut

SUPREME COURTOr ILLINOIS vs. aurvcoRpoooNptmmFF VS.NAME 510 CLERK

(Last) (FIrU)

ADDRESS

(Strcct)CITY STATE ZIP

DR LIE.

The Undersigned states that on II at AM. P.M. Defendant did unlawfully operate:

REOISTR STATE YEAR US DOTNO

MAKE YEAR COLOR

wEl FPISIAN w El iruvruNDsI-iR4e AI2El PASC4R UEnseseswluALsIusvrsIcLc NUND poElrunEl s HeEl TPLDCIkSCItR 060El RECREATIONAL VEIl PLAcsRwZ MSISS1IAL VINEl YPOD013El VUItnE-NU.E El OTHEHCUDA5/ - I6ORUOREPASI,VEHICLE NESEl NOEl

Upon a ic H7way, or other Lafion, edIIy

______________________

Located in the County and State Aforesaid and Did Then and There Commit the Following Offense El URBAN DISTRICT

INC. 625 ILCS 5/:

O 3-707 OPERATING UNINSURED VEHICLE El II-RRRLJ u.RRISLTRANwVJrnna.LslctBtc

El VIOl NO VALID DR’S UCD/SE 0 IlAUlla) FAllLBEmE-AT

El 6.iO3(_JSRFONGW1)ICELICENSHSESPENDEDREVOKES 0 iI-AYI SPW]NO NINA 7451EHE

• 0 11-305 DISOBEYiNG INAFFIC CONIROL DEVICE 0 II-7nN(J CSISECIERLANELSSLE

• El II-501(a)L_]DRIVINGENDER INTLUENCE

ACT

El 12403.1 rAJLLRE1ovmAzaE4TsaJ (_JD LJP

rcuoocr1’vw El osisus nouiyty El El BmKV1ALDEWJO’ El FSINL SEP NOPCiaDCThUNna El WET El osv El 042W El RE

NISRRUTr7 El DAY El NICHOC El RAIN El SUJW El INTl El QATARS El IRHRSDAR I. El mun1cus a El RNliSR a El AQSAFC El rruasoD s. El vsss

NOTATIONS

El C GC?1/I) 7, El AARSt K El ACCIDOAT H El OINITS

BOND INFORMATION Hen rri40e PEflrss. bacH 1e of Go6El R2LAMr

I CASH El CURRENCY I

____________

El ERASES

____________

AUTH I

________________________________

EIOSS

0 2. IL DRIVERS LICENSE 0 3. BOND CARS NO.___________________________ ISSUED BY:_______________________________

0 4. HONG POSTED ON TICKET NO._____________________ El 5.N0 HONE-CONTINUE AT

__________________________

0 NTOTICETOAPPLSR 0 7.PROMISETOCONIPLY 0 I..INDIVIECACBOND IFULL)AMOI.’NT I_____________________

Vffv1Th3WL1 I p toaxrIyWU, iiffisTati

SIONAWEE XCIRCUIT COURT LOCATION AND DATE

ADDRESS /COURTHOUSE

AM.CITY ZIP I ON AT P.M.

E COURT APPEARANCE REQUIRED D IiQ COURT APPEARANCE REQUIREDSee instructions on top portion, back side of Gold copy

Under penalties as provided by law for false certifcation pursuant to Sechon 1-109 of the Code of Civil Procedure and perjury pursuanl toSection 32-2 of the Criminal Code of 1961 the undersigned certifIes that the statements set forth in this inslwmRnl are true and correct.

/ /

________________________________

MONTH DAY YEAR CCFICEES SIGNATURE ID NO

NOTE: USE SEPARATE CITATIONFOR EACH VIOLATION

2Ol4DUniform Traffic Citation - Vehicle Use__2O9-15.Revised Traffic_Citation - Increase Boni.qxd 4/3/2014 10:04 AM Page 2

COMPLAINT COPYBACKER

Vehicle types as defined in 625 ILCS 5/I et seq. and recorded in the Vehicle Section of the Citation.

CODE

+

000 .IRBOAT

OUt LL TERRAIN VEhICLE (ATV)

002 ,MBULANCE

003 NTIQUE VEhICLE

—— cntse DF$CRIPTION

049 ON-POWERED WATERCRAFT

050 FF.IIIGIIWAY MOTORCYCLE

05 t RGAN TRANSPORT VEhICLE

052 ASSENGER CAR

004 IAPPORTIONABLE SEMI-TRAILER 053 tEDESTRIAN

005 PPORTIONABLE TRAILER 054 ERSONAL WATER CRAFT

006 UTIIORIZED EMERGENCY VEIIICLE 055 OLE TRAILER

007 ICYCLE 056 OLICE VEhICLE

008 0AT/WATERCRAFT 057 ASLROAD TRACK EQUIPMENT

089 us 056 1AILROAD TRAIN

OtO AMPING TRAILER 059 SEBUILT VEIIICLE

Ott IIARITABLE VEhICLE 060 ECREATION VEhICLE

0t2 OMMUTER VAN 06t ECREATIONAL BOAT

013 ONVERTER DOLLY 062 ECREATIONAL OFF-IIIOIIWAY VEHICLE

0t4 USTOM VEhICLE 063 EPAIRED VEhICLE

015 YCLE 064 EPLICA TROLLEY

0t6 RRELICT VEIIICLE 065 ESCUE VEIIICLE

Ot 7 LECrRIC PERSONAL ASSISTIVE MOBILITY DEVIC 066 GAD TRACTOR

0t8 YPANDED-USE ANTIQUE VEIIICLE 067 ORAL MAIL DELIVERY VEIIICLE

0t9 ARM TRACTOR ] 068 SAILBOAT

020 IRE DEPARTEIENT VEhICLE 069 IIOOL BUS

02t LEET SAFETY VEHICLE ] 070 NOWMOBILE

022 OREIGN VEHICLE PECIAL hAULING VEhICLE

023 OLE CART ] 2 PECIAL MOBILE EQUIPMENT

024 kEY MARKET VEhICLE 1 073 PECLALLY CONSTRUCTED VEhICLE

025 OUSE TRAILER 074 PECIALTY PROP CRAFT

026 MPLEMENT OF hUSBANDRY 075 TINGER-STEERED SEMITRAILER

027 UNK VEIIICLE 076 TREETCAR

020 IFEBOAT 077 TREET ROD

029 IMOUSINE 078 ANK VEhICLE

030 OW-SPEED ELECTRIC BICYCLE

031 OW-SEEEO GAS BICYCLE 080 TRACKLESS TROLLEY COACH

032 OW-SPEED VEIIICLE 081 RAILER OR SEMI-TRAILER

033 ATERIALLY ALTERED VEIIICLE 002 RANST BUS

034 AXI-CUDE VEHICLE 083 RAVEL TRAILER

035 IEOICAL CARRIER 084 RUCK

836 EDICAL TRANSPORT VEIIICLE 005 RUCK CAMPER

037 ODIFIED VEHICLE TRACTOR

038 OTORBOAT 087 TRUCKSTER

039 OTORIIOME, MINI-MOTORIIOME, VAN CAMPER 088 JEYPE I SCIIOOL BUS

048 OTOR VEIIICLE 089 TYPE II SCHOOL BUS

04t IOTOR DRIVEN CYCLE 090 TEILITY SERVICE VEIIICLE

042 FIOPED 091 VRECKER

043 4OTORCYCLE 998 TIlER

}TORIZED WIIEELCHAIR 999 ONE

045 MULTIFLNTION SCHOOL ACTIVITY BUS

046 COPURPOSE PASSENGER VEIECLE

047 ONCOMMERCIAL VEIIICLE

048 ON-DIVISIBLE LOAD OR VEIIICLE

2014Uniform Traffic Citation - Vehicle Use 2Qrc1915Revised Traffic_Citation - Increase Bon1qxd 4/3/201 4 10:04 AM Page 3

NOTE: USE SEPARATE CITATION

FOR EACH VIOLATION

iii ‘iii vii ii ii ui ii iii VIII c f. 0 0 o c: 0DCNI

CASE tSP DISTNO OCT. REPORT OF CONVICTIONCOUNTY TOWNSHIP U TWPOP OP

RDPEOPLE STATE CITY? VILLAGE OFOF ILLINOIS VS MUE1OPuLEORPOEA000FLAINOII?

VS.NAME SiD#

(Lao) (Pen) 5 N I.)

ADDRESSEYES 0 EA.A

tStreat( (Aff S 0 M.ACITY STATE ZIP HAIR HEIGHT WEIGHT

DR. LIC, EXPIR DATE DATE OF

STATE CDI.

The Undersigned states that on /1 at AM. P.M. Defendant did unlawfully operate:REGISTR. STATE YEAR US DOT#NO.

\IAKE YEAR COLOR

0130 ISOENIRIAN wID llTEI-13LSD (520 PA52ECEA CONMvEIUALNUIUE.VONQJO Yr/RD r0soD es soD /R&EXTR4CIUC NDD SncT01LNsuR OCARiE)HAZ MSfl]SML N/RD FaJD0130 SUItI52NUL 0 Ofl-ERCt3S)

_________________________________

I600NUSEPAUE NI/NODE ‘A/RD noD

Un a Public Highway, or other Location, edfically

__________________________

Localed in the County and Slate Aforesaid and Did Then and There Commit the Following Offense U URBAN DISTRICT

l.V.C. 625 ILCS 5/:

U 3-707 OPSRA7(YGUN(NSYREDYES?CLU U II-R0O(_JU1IC1SLTRANREUEa1AL0Mi

06-IOI NO VALIDDRIVER’S LICENSE U I-AIIM) FAILuRDTORELi,tE(5’EEIx5oDISr

• U 6-303 (,__ DRIVING WSILE LICENSE SUSPENDED/REVOKED U II-enthln

• 0 11-105 DISOBEYING TSAFFIC CONTROL DEVICE U ?I-7wl__)ML4DroLS

• D U.50IM5( (DEWING ErNOER INFLUENCE

ACT

U 12-en FAILLRETO(5EORsuSTBUT f_JO (__)P

ALU1C1YPO 0 DRV000UIISYDALY 0 FWNTEWONM’ET( 0 PISKR/N1SLD&RY 0 F/REAL REP. NO.

RGSOGI’UDUF& DWNC Dti<’ Dsow Den— VISI01UTY 0 ON’S’ 0 niceti 0 RAN 0 eosv 0 wo 0 arto

NEI3W ci 0 HHRAOAR I. 0 FLAINcAR z 0 RADAR 3. 0 AURAPE 0 MARKEO N 0 VAAR

NOTATIONS

0 c eceen 7. 0 ANISE 6 0 ACUDEAET 0 omen

BOND INFORMATION (see ndds PEON baAI dde of God eepy) 0 IULAMU

I CASH 0 CURRENCY 5 0 0-BOND I

_____________

ACtS, 0 aM

O 2. IC DRIVERS LICENSE U 3. BOND CARD NO.___________________________ ISSUED BY’_______________________________

O 4. BOND POSTED ON TICKET NO._____________________ 0 5. NO BONEACONHNTDAT

__________________________

O 6. NOTICE TO APPEAR U r. PeOMISE TO COMPLY U 6 INDIVIDUAL SOND (FL’LL) AMOUNT $_____________________

WIOJr1Uffl1N1ZWLT I p occrTpywthti UisTa

SIGNATURE XCIRCUIT COURT LOCATION AND DATE

ADDRESS?COURTHOUSE

AM.CITY ZIP IL ON AT NM.

D COURT APPEARANCE REQUIRED D COURT APPEARANCE REQUIREDSee instructions on top portion, back side of Gold copy

Unaar penalties as provided by law for ta/se cerSflSion pursusnt to Secton i-i a’ the Code of Civil Procedure and perjury pursuant toSechon 32-2 of the cdminal Code of 1961, the undersigned certifies that the statements set forth in this instrument are true and correct.

/ /

_______________________________

MONTe SAY YEAS OEOCCR’SSIGYATSRE 0 SO

NOTE: USE SEPARATE CITATIONFOR EACH VIOLATION

--

2O14Uniform Traffic Citation - Vehicle Use209-15.Revised Traffic_Citation - Increase BonJ.qxd 4/3/2014 10:04 AM Page 4

REPORT OF CONVICTIONBACKER

Court Action and Other Orders

ORIGINAL CHARGE

AMENDED CHARGE OR LESSER INCLUDED OFFENSE Of:___________________________

625 ILCS 5!

_______________________________________________________________________________

H ILCS H LOCAL ORDINANCES CH.

________

ACT

_______/SEC.__________

DATE

H PLEAD GUILTY / /

H PLEAD NOT GUILTY / /

FINDINGS:

NOTE: A DISPOSITION IN THIS COLUMN WILL RESULT IN THE NOTE: A DISPOSITION IN THIS COLUMN WILL ] RESULTSECRETARY OF STATE RECORDING A CONVICTION ON THE IN THE SECRETARY OF STATE RECORDING A CONVICTION ONDRIVER’S RECORD THE DRIVER’S RECORD

GUILTY (CONVICTION) H NOT GUILTY

EXPARTE H NOLLEPROSEQUI

BOND FORFEITURE H DISMISSED

H SUPERVISION VACATED / JUDGMENT ENTERED H STRICKEN ON LEAVE TO REINSTATE+ H CONDITIONALDISCHARGE H COURTSUPERVISION

PROBATION H om

H OTHER

/ /DATE ORDER ENTERED

SIGNATURE OF CLERK

FOR SECRETARY OF STATE USE ONLY:

COURT DATE OF CONVICTION COUNTY Of RESIDENCE LAW SECTION SUBSECTION

SEND TO: SECRETARY OF STATE

DRIVER SERVICES DEPARTMENT

2701 SOUTH DIRKSEN PARKWAY

SPRINGFIELD, ILLINOIS 62723

--

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NOTE: USE SEPARATE CITATION

FOR EACH VIOLATION

II Ih AI II VII II II Ih HI J 3 0 J

DCNI

CASE ISP 01ST.NO, 0CC. COURT DISPOSITIONCOUNTY TOWNSHIP U 1wPOF OF so

PEOPLE STATE CITV.’VILLAGEOFE OF ILLINOIS VS EWT7i1POLcORPOEAYOHPLOENoc

vsNAME SID#

(Last) (First) ( M IADORESS

EYES C(Street) (Apt.) 0 MHe

CITY STATE Z[P HAIR HEIGHT WEIGHT

DR LIC DCPIR DATE DAThOF

6TATF CDL IThe Undensigned states that on __j_I_ at AM. P.M. Defendant did unlawfully operate:

REOISTR. STATE YEAR USDOT#NO.

MAKE YEAR COLOR

NEC rocmIso asiC 1NEJL11RvTs. ocD ooawsc ccwwwueurarssvtseaj s0 noDtoeD ws weD iuucm.scitn weD RECREATIONAL 01 ISHCARI1DWeZ MVIENIAL SEND noD0130 NUIS)WNU.E D OTT1ERCODE)Si I6ORMOREPASS,NEHiLLF SFSD NOD

Upon a Public Highy, or other Locotion, edficolIy

__________________________

Located in the County and State Aforesaid and Did Then and There Commit the Following Ofienae U URBAN DISTRICT

l.V.C. 625 JLCS 5/:U 3.707 OPESATINO LNINSURED VEHICLE U

U NIGi NO SALlE DRIVOKS LICENSE U Il-01t)H) FAflJ.ew1oR.ALuIr• U 6-303_] DRIVING WHILE LICENSE SUSPENDED/REVOKED U It-Wi)b) RI_N1NA_AAR

• U li-IS) DISOBEYING TRAFFIC CON100L DEVICE U II-7w(_JneLAweLB

•

NATURE

INFLUENCE

ACT

I2-ir EloSocAwocwweT )O(S F

AUUUITATTtIT. D OSINT/RDOE/RYG4LY D ptREllj{WOSMrsUL D wRwLocJun’ 0 FAtAL REP. nO.IR3ADUUEUflG D sstsr D nw D wew D IcE

vwwuiv 0 GAY 0 ncsrr 0 RAN D SMJSV D iuj D CIJARNED-UT 5 0 HHR4GHR I. 0 PLANCIR 2 D RAGAR 3. 0 AQKAFC 4. 0 notticca A 0 vAW.AR

NOTATIONS

6 D c Bc? 7. 0 wesr R 0 ALEI000T o. 0 ont-

BOND INFORMATION (seenAedepbadesRIeo1Gotdpy)OSULAME

I CSSH U CURRENCY S

____________

0 E.BONE I

____________

ALTO)

________________________________

Don,0 2 IL ORIVERD LICENSE U S. BOND CARD NO,___________________________ ISSUED BY’_______________________________

0 . BOND POSTED ON TICKETNS

_____________________

0 5.NS BOND-CONFINED AT

__________________________

0 6 NOTICE TO APPEAR 0 7 PROMISE TO COMPLY U 8. INDIVIDUAL BOND (PULL) AMOUNT S_____________________

WWOJMTUIA3OJLT I p to yWthti09ta1TscfflisT au

SIGNATURE XCIRCUIT COURT LOCATION AND DATE

ADDRESS!COURTHOUSE

AM.CITY ZIP tL ON AT P.M.

D COURT APPEARANCE REQUIRED COURT APPEARANCE REQUIREDSee instructions on tcp portion, back side of Gold copy

Order penahies as provided by law for false certification pursuant to Section 1-109 of the Code of Civil Procedure and pRury pursuant SDSection 32-2 of the Cdminal Code of 196f, the undersigned certifies that the statements set forth in this instwment are true and correct

/ /

_______________________________

MONTH DAY YEAR OFFiCERS SIGNATURE in so

NOTE: USE SEPARATE CITATIONFOR EACH VIOLATION

-€-

ORIGINAL CHARGE

AMENDED CHARGE OR LESSER INCLUDED OFFENSE OF:

ELI

625 ILCS 5/

ILCS LI LOCAL ORDINANCES CR.

________

ACT

_______‘SEC.__________

BAIL FORFEITURE

LI 1 CASH OR

I. GUILTY

2. NOTGUJLTY

3. NOLLE PROSEQUI

4. EXPARTE

5. DISMISSED

FINE S

6. TURNED OVER TO OTHER AUTHORITY

7. CHARGES AMENDED

8. STRICKEN ON LEAVE TO REINSTATE

9. ASSIST

10. COURT SUPERVISION

COSTS

RESTITUTION

TOTAL

$

$

S

NAME

STREET

CITY STATE ZIP

MAIL TO:

SIGNATURE OF CLERK

2014-Uniform Traffic Citation - Vehicle Use1Q,rc19-15Revised Traffic_Citation - Increase Boni.qxd 4/3/2014 10:04 AM Page 6

HEARING JUDGE

COURT DISPOSITIONBACKER

LILI

Court Action and Other Orders

ut,flu _.ts1x1J / /

DATE

LI 2. LICENSE / /

LI 3. WARRANT ORDERED TO ISSUE / /

LI . NOTICE OF FAILURE TO APPEAR FILED (PROMISE TO COMPLY) / /

LI 5. INDIVIDUAL BOND

FINDfl’IflS

/ /

DATE

LI

LI

LI

LI

LI

+

-*-

2014-Uniform Traffic Citation - Vehicle Use .2rfl9-1 5.Revised Traffic_Citation - Increase BonJ.qxd 4/3/2014 10:04 AM Page 7

NOTE: USE SEPARATE CITATIONFOR EACH VIOLATION

AII II DI VIh Ih NhI tJ J c f c cDCNI I

CARE 1SF DIST.NO. occ, POLICE RECORDCOUNTY TOWNSHIP C] rwi’OF OF

RDPEOPLE STATE CITY VILLAGE OFOF ILLINOIS VS s,rNxlpnl.coRrt,evm,NrcAncnpF

VSNAME SIDS

(Lsr) (First) (MI.)ADDRESS

EYES C])StrNcti (Apt.) C] MAS

CITY STATE ZIP HAIR HEIGHT WEIGHT

DR. LIC DATE DAThOF

STATE CElL IThe Undersigned states that on II at AM. P.M. Defendant did unlawfully operate:

REGISTR. STATE YEAR US DOTNO,

MAKE YEAR COLOR

3030 IVLS70IRIAN 0610 3RA1b30TI-1RAL 3020 PAA0CSR Ct30vK1SLNU1UNUN-SQL vrsD oQ3090 DUE 0660 TSKEXTRAflPR 5500 RSCREST1UNAL VEIl ELYCARI.fl)HAZ NIATOSAL NEED pjQ5130 YUIAU.L 0 OTHER CODE(S) 16 OSMOSE PASS. VESICLE SF50 soD

Upon a Public Highway or other Loon, eUflcally

___________________________

Located In the County and State Aforesaid and Did Then and There Commit the Following Offense C] URBAN DISTRICT

J.V.C. 625 JLCS 5/:0 3-707 OPERATiNG UNINSURED VEHICLE C] lIVE ),,.j IUI,L1RATASUOCA2TOSALECB4EL

C 6-IS) NO VALIE DRIVER’S LICENSE C lI-WOo) FA01REiOROS.CY51’.°CUoT•

0 6.303 (_) DRIVING WSILE LICENSE SESPENDEDJRRVOKDD C IIWItH) 0707570301 7s370 INA?11-IZITAE

• C Il-Sot DISOBEYING TRAFFIC CONTROL DEVICE C II-TW,,,J 151 la LANE LEAVE

•

ThLCSCIErALCINPLUE:E

C I2-W3 AILLRE1OS5IMRSESTREIT LJ0LJP

ACEIWACTrIK C] EISHT]REOLS{YUT’LY D PIlaIJTWI)NMAVE 0 IiDSDUNSLNIIRI C] FATAL REP NORESDcVEUIIVEIN 0 SYRIF 0 ticy 0 wayw

a 51303011W 0 OW 0 HIGOC 0 RAN 0 wuw 0 NAT C QLARNEIWD 0 0 HHRAOAR I. 0 FLAINcSR 2 0 RALIAN 1 0 AERAFP 4 0 MARIOT3 N 0 VAALAR

NOTATIONS

H 0 C 30VE 7 0 AN70 K 0 AUtIDPUCT S 0 OTS

S3OND INFORMATiON(see toddle paStor boW sMe of Odd C EULAME

I CHSR C CURRENCY I

____________

C E.ROND S

____________

ARTS.

________________________________

C IR%

C 2, ILDRIVER’S LICENSE C 3.BONDcARDN0._________________________ ISRUEDBY____________________________

C . BOND POSTED ON TICKET NO

_____________________

C 5, NO BOND-CONONEDAT

__________________________

C] 6 NOTICE TO APPEAR C 7 PROMISE TO COMPLY C 6, INDIVIDUAL ROND (PULL) ASSOLNT $_______________________

woJr1mhwL1 I puiitoyWthUek refrisTda

SIGNATURE XCIRCUIT COURT LOCATION AND DATE

ADDRESS /COURTHOUSE

II A.M.CITY ZIP IL ON AT P.M

D COURT APPEARANCE REQUIRED COURT APPEARANCE REQUIREDSee instructions on top portion, back side of Gold copy

Under penaSios as provided bylaw (or false certitirslion pursuant to Section 1-109 of the Code of Civil Procedure and perjury pursoant toSection 32-2 of the Criminal Code of 1961, the undersigRed certifies that the statements Set forth IT this instrument are (rue and correct.

/ /

_______________________________

MONTH Ovy Yrno orrIcoes SIGNAlS/RE 0 NO

NOTE: USE SEPARATE CITATIONFOR EACH VIOLATION

2014-Unjform Traffic Citation - Vehicle Use 29-15 Revised Traffic Citation - Increase Bonjd.xd 4/3/2014 10:04 AM Page 8

POLICE RECORD BACKER

BLANK

+

2014-Uniform Traffic Citation - Vehicle Use__2I0fl9-15.Revised Traffic_Citation - Increase Bonkl.qxd 4/3/2014 10:04 AM Page 9

NOTE: USE SEPARATE CITATION

FOR EACH VIOLATION

UIII DIII 1101 DIII 1111 1111 11111 DIII UIh 0 0 0 0 0 0 0DCN

VIOLATORCOUNTY TOSUNSHIP D TWPOF OF

PEOPLE STATS CITY! VILLAGE OFOF ILLINOIS VS. souuarui.coousonre vs

NAME SIGH

(List) First) ( N I)AGGRESS

EYES 0(Stre;t) (Apt) a star

CITY STATE ZIP HAIR HEIGHT WEIGHT

DR LIC. 1EXPIR DATE DATE OF

STATE CDL IThe Undersigned states that on /1 at AM. P.M. Defendant did unlawfully operate:

REGISTR, STATE YEAR US DOTSNO.

MAKE YEAR COLOR

sD NIiINISIAN IBID lkSlL30TsI-1R?JL es2D HHRROsEB]ECSR CUSMESOETALNUIUEVVIeQE YlGa roDWHO n rasiD iiiwcmsnuu tsoD RECREATIONAL VEIl SLASCI(DBEAZ MAT320AL NYSO oDSS3a SfJItECNU.E a OTRERCIIDE(S) SORMORCFAAS.VERICLE; YTSO NOD

Upon a Pubic Hghway, or other Lotton, edflcally

_____________________

Lecated in the County and State Aforesaid and Did Then and There Commit the Foiowing Offense UREAN DISTRICT

tDrTTNNt a TOL30YNY a IVEWOFU5GAURKE a a POEM. REP SOa YSI D a a

NISI30UTY DAY D MG{C a lENIN 0 e a a wuotsa HHRSGSR I. a a RADAR 0 ACRAFC 4 D a

NOTATIONS

a c 30CEtD . 0 ,SC a AcCIGUNT 9, 0

BO’D INFORMATIOIs paar, beds st2e oR DoRO espy)

I.CASH 0 CURRENCY $

__________

0 E-BOSD I

__________

AUTH.R

___________________________

DI0Y5

D 2. IL DRIVER’S LICENSE 0 3. BOND CARD NO._________________________ ISSUED SN

____________________________

04. BOND POSTED ON TICKET NO._____________________ 0 5. NO RONINCONFINEDAT

__________________________

0 6. NOTICE TO APPEAR 0 n. PROMOETO COMPLY 0 INDIVIDCAL SONS (FULL) AMOUNT 5

WJ1ThGJLT I puri cmçlyWthty’eim Cf tNSTad

SIGNATURE XCIRCUIT COURT LOCATION AND DATE

ADDRESS,COURTHOUSE

AM.CITY ZIP L ON AT P.M.

D COURT APPEARANCE REQUIRED D tj COURT APPEARANCE REQUIREDSee instructions on top portion, back side of Gold copy

Under penafties as prnvided by IBW for false certiflcatSn pursuant to Sect’on 1-109 of t(e Code of Cod Procedure and perijry pirsuant toSRC(Sn 32-2 of the Criminal Code of1961, the undersigned certifies that the statements set forth in this instrument are true Snd correct.

I /

_______________________________

MONTH DAY YEAR OFFICERS SIGNATURE ID NO

NOTE: USE SEPARATE CITATION

FOR EACH VIOLATION

CASENO

ISP GIST0CC

4..

0 ILCS 0E41alDAo

NATURE OF OFFENSE

D 3-707 OPERATING UNINSURED VEHICLE

0 6-ISINO VALtD DRIVER’S LICENSE

D 6-303 (_,) DRIVING WHILE LICENSE SCSPENEEE(REVOKRE

0 11-303 DISOBEYING TRAFFIC CONTROL DEVICE

D Il-SElls) )__j DRIVING UNDER INFLUENCE

1.V.C. 625 ILCS 5/:

0 II-5AP(_JG1JAT4L1R9S30SSTWfl1ALCUTU

O Il-HulA) CAILR.HE’IORELTIEAPEIEYPECIIIS6T

0 Il-HulIb)

O 11-7330)_I UCERL4N!I.SACW

0 I2-HH.I FAOLRE1OWEARDRATBHuI )_J D )_J P

+CS._________ ACT

___________(SEC __________________________

2.014-Uniform Traffic Citation - Vehicle Use2ffl9-15.Revised Traffic_Citation - Increase BonI.qxd 4/3/2014 10:04 AM Page 10

READ THESE INSTRUCTIONS CAREFULLYIf your ticket is marked (X)”COURT APPEARANCE REOUIRED”:You are required to come to court on the date, time and place noted on the front side, bottom half of the ticket in the Court Place/Date” section. However, if you want to plead “NOT GUILTY”, complete the formentitled ‘Avoid Multiple Court Appearances” on the top half, of the back side of the blue copy.

If your ticket is marked (X) “ COURT APPEARANCE REQUtRED” you have the following two (2)options:

1. If you wish to plead “GUILTY”, complete the form entitled “PLEA OF GUILTY AND WAIVER” on thebottom half, of the back side, of the blue copy of the ticket. Follow the instructions on that form and mail itwith full payment of fine and costs. The amount of fine and costs are noted below.

Fines and CostsThe fine and costs where court appearances arc gg required are:

(a) S 120.00 for all complaints, except (b) and (c) below;(b) $60.00 for seat belt violations cited under 625 ILCS 5/12-603.1;(c) $140.00 for speeding than mph but ggg than mph over the limit.

NOTE: Payment must be by cash, money order, certified check, bank draft, or traveler’scheck unless otherwise authorized by the clerk of the court. (DO NOT SEND CASH INTHE MAIL; use cash only if paying in person.)

2. If you wish to plead “NOT GUILTY”, complete the form entitled “Avoid Multiple Court Appearances”on the top half, of the back side, of the blue copy and follow those instructions.

BOND INFORMATION - FAILURE TO APPEARThe type of bond you posted is marked on the front side of the ticket in the “Bond” section. The result of your failure to appear or pay this ticket is determined by the bond type identified below and whether your ticket is marked“Court Appearance Required” or “No Court Appearance Required.”1. CASH:

A. FULL CASH BOND:1. No Court Appearance Required: Ajudgment may be enlered against you for fine, penalties, and costsas provided in the NOTICE below.2. Court Appearance Required: A judgment may be entered against you for fine, penalties, and costs asprovided in the NOTICE below. Or instead, a judgment may be entered for the FULL amount of the bond,and/or the court may issue a warrant for your arrest. Any cash deposited will be applied toward the judgment.

B. 10% CASH BOND: Ajudgment may be entered for the FULL amount of the bond and/or the court may issuea warrant for your arrest. Any cash deposited will be applied toward the judgment.

2. ILLtNOIS DRIVERS LICENSE: A judgment may be entered against you for fine, penalties, and costs as provided in the NOTICE below. Or, instead, your driving privileges maybe suspended, and/or the court may issue a warrant for your arresC3. BOND CARD:

I. No Court Appearance Required: A judgment may be entered against you for fine, penalties, and costsas provided in the NOTICE below. Your card will be sent to the issuing company for payment.2. Court Appearance Required: A judgment maybe entered against you for fine, penalties, and costs asprovided in the NOTICE below. The card will be sent to the issuing company for payment. Or, instead, ajudgment may be entered for the FULL amount of the bond, and/or the court may issue a warrant for yourarrest.

4. BOND DEPOSITED IN TICKET NO. (see front side for number): The bond which has been posted in another ticket also covers this ticket.5. NO BOND: You were unable to post bond with the arresting officer at the time this ticket was issued.6. NOTICE TO APPEAR: Ajudgment may be entered against you for fine, penalties, and costs as provided in theNOTICE below. Or, instead, the court may issue a warrant for your arrest.7. PROMISE TO COMPLY (out of state drivers only): A notice of suspension of your driving privileges will besent to your licensing state; Or, a judgment may be entered against you for fine, penalties, and costs as provided in theNOTICE below; Or, the court may issue a warrant for your arrest.8. INDIVIDUAL BOND: A judgment may be entered against you for fine, penalties, and costs as provided in theNOTICE below. Or, instead, judgment may be entered for the FULL amount of the bond and/or the court may issuea warrant for your arrest.

NOTICEOF CONSENT FOR ENTRY OF JUDGMENT

If a driver’s license, cash bail, bond certificate, or an individual bond was posted or if you werereleased on a Notice to Appear or Promise to Comply and you were charged with an offense which doesnot require a court appearance, YOU ARE HEREBY NOTIFIED THAT:

In the event you fail to appear in court or answer the charge on the date set for your court appearance, or any date to which the case is continued, or you do not submit a written plea of guilty to the clerkat least (3) days before that date, you thereby consent to the entry of a judgment of conviction againstyou in the amount of the applicable fine, penalties, and costs. The cash bail or other security depositedwill be used to pay the fine, penalties, and costs. If you are an Illinois Driver and you fail to pay in full anyjudgments imposed, a notice will be sent to the Secretary of State and your driver’s license will not berenewed, reissued, or reclassified, until full payment is received.

2014-Uniform Traffic Citation - Vehicle Use 2t0f19-1 5Revised Traffic_Citation - Increase Bonxd 4/3/2014 10:04 AM Page 11

NOTE: USE SEPARATE CITATIONFOR EACH VIOLATION

iii ii ii ii iii i’ii ni ii liii f f t f: c f:

CASINO

DCN I IISP 01ST0cc. COURT COMMUNICATION

COUNTY TOWNSHIPOF OP

RDPEOPLE STATE CITY/VILLAGE OPOF ILLINNOIS VS MGPHLCOPYOHDONrG0INUFF

vs.NAME 510

(LsoI ENrol ( ML)

ADDRESSEYES D

lSrrrol (Apr) C MA

-

CITVSTATEZIP HAIR HEIGHT WEIGHT

DR LIC, EXPIR. OATS DATE OF

STATE CDL IThe Undersigned states that on II at AM. P.M. Defendant did unlawfully operate:

REOISTR. STATE YEAR US DOTeNO

MAKE YEAR COLOR

W3D FREI/SISIOJS GIlD ThAlljDUI-’IRAL DUD PADUTEDUCSR awewaoocoAuruscwvrsao.c VEND rrsD(ePIC DUB (SAD 73(LQ(’ITNCIDR NED RECREATIONAL E5. aecNaIiDIIAz MA7RI3IAL NI/sD NODOI3D SUItS(CSUE D O/’IIERCOEE/Sl I6SRMORRPASS.VEHICIt 0)/sD NOD

Upon a Public HgIiway, or other Loon, Jeafifly

______________________

Localed in Ihe Cojn(y and Slate Aforesaid and Did Then and There Commil the Following Offense U URBAN DISTRICT

I.t’C. 625 ILCS 5/:U 3r707 OPERATING UNINSUREE VEHICLE U II-3RE1_JS1NORL1RGIRInDRI1a4AL.

0 6.101 NO VALID DRIVERS LICENSE C ILSAIod FAII_HE1ORWCYACU1T• 0 6.303 _J DRIVING WHILE LICENSE SUSPENDED/REVOKDD 0 ILSAI)b) OPTS/DOD 5451 DIANEHZD’E

• U 11-3/5 DISOSEYING TRAFFIC CONTROLDEWCE U II-TRRI,__) Mwca’EJRLSISELSOSNO

•UH-5GI)I__)DRTJINGLTSDERINFLRENCE

ACT

I2AD-!ENIUS/E1OVVSORREATBGZ (_JO I_]P

.NLUIDO)rrVFU D Rvowmou{yaay D rssiuovosr C XrIALD’DIRY C PAESL REP. NORQDCU1S]TDW C ssur D y C anw Cbs

sosiwmy C no’ D sacoar D RAJIrt C w D no C Cl/DRNI/IWO S C HHRADNR I. C PLSINCRR i C NA/DR 3. C AENAFT 4. C MNDKD) . C vrtw

NOTATIONS

6 C c RIFUDU T. C AEHST & C ACTIDRICT 5 C 0/sEE

BOND INFORMAJ1ON(see nddde passe, band ode alGeR sepy) C FULAMT

I CASH C CURRENCY I

____________

U E-SOND I

____________

ACTS

________________________________

C 10%

U 2.ILDRIVER’SLICENSE U 3.BONDCARDSO._________________________

____________________________

0 4. BONE POSTED ON TICKET NO

_____________________

U I. NO BOND-CONFINED AT

__________________________

0 R. NOTICE TO APPEAR U n PROMISE TO COMPLY U INDIVIDUAL BONE (FULL) AMOUNT I_______________________

VtOW1Tht’3WL1 I putitoyW nmllisTat]

SIGNATURE XCIRCUIT COURT LOCATION AND DATE

ADDRESS’COURTHOUSE

AM.CITY ZIP ON AT P.M.

D COURT APPEARANCE REQUIRED D fj COURT APPEARANCE REQUIREDSee instructions on top portion, back side of Gold copy

Under peeehes as prosided by law for false cerhfcahon pursuant to SechDn 1-log of the Code of Clot Procedure and perjury pursuant toSecbon 32-2 of the Criminal Code oflSSl, the undersigned cerlif as that the slatemento seb forth In ths ir.stwmenl are RIse and crrecI.

/ /

_______________________________

MONTH DAY YEAR OFF/C IRS SIGNOr/RI, LD. ND

NOTE: USE SEPARATE CITATIONFOR EACH VIOLATION

--

2014-Uniform Traffic Citation - Vehicle Use2lc19-15.Revised Traffic_Citation - Increase BonI.qxd 4/3/2014 10:04 AM Page 12

MAILING ADDRESS

CITY STATE ZIP

TELEPHONE NUMBER

GUILTY PLEA

If you intend to plead GUILTY to the ticket and No Court Appearance is Required:

1. Complete this fonm

2. Mail this form, together with the fines and costs to the Clerk of the Court, Traffic Section, at theaddress noted in the “Court Place/Date” section on the bottom half of the front side of this tiekeC Youmust mail this completed form, with all fines and costs, no earlier than ten (JO) work days after theticket was issued (noted on the top half of the front side of the ticket), and no later than three (3) workdays before the court appearance date (noted on the bottom half of the front side of the ticket in the“Court Place/Date” section).

FINES AND COSTSThe fine and costs where court appearances are not required are:

(a) $120.00 for all complaints, except (b) and (c) below;(b) $60.00 for seat belt violations cited under 625 ILCS 5/12-603.1;(c) $140.00 for speeding gg than mph but pqg than mph over the limit.

NOTE: Payment must be by cash, money order, certified check, bank draft, or traveler’scheck unless otherwise authorized by the clerk of the court. (DO NOT SEND CASH INTHE MAIL; use cash only if paying in person.)

PLEA OF GUILTY AND WAIVER

I, the undersigned, do hereby plead guilty to the charge noted on the front side of this ticket. I understand my right to a trial, that my signature to this plea of guilty will have the sameforce and effect as a judgment of court and that this record will be sent to the Secretary ofState of this State (or of the State where I received my license to drive). I hereby PLEADGUILTY to the said offense on this ticket, GIVE UP my right to trial, and agree to pay thepenalty required.

DEFENDANTS SIGNATURE DATE

MAILING ADDRESS STREET

CITY STATE ZIP

AVOID MULTIPLE COURT APPEARANCES

If you intend to pleadI GUILTY to the ticket:

1. Complete this form and mail at least TEN (10) svork days before the date set for your court appearance noted on the bottom half of the front side of this ticket (Court Place/Date section).

2. Indicate what kind of trial you want—mark only one box, complete the address section below andfollow the mailing instructions in number 3 below.

I WISH TO PLEAD NOT GUILTY AND REQUEST: D A. Trial by Judge

B. Trial by Jury

A new appearance date will be set and you will be notified of the time and date of trial. Donot come to the court until you are notified. When you are notified, you should come tocourt prepared for trial and bring any witnesses you may have.

NAME

3. Mail this form to the Clerk of the Court, Traffic Section, at the address noted in the “CourtPlaceDate” section on the bottom half of the front side of this ticket.

DO NOT MAIL TO THE POLICE DEPARTMENT

FILEDILLINOIS CITATION AND COMPLAINT

(Uniform Traffic Ticket)$UPRE7E COURT

PRINTING INSTRUCTIONS CLERKTHE ATTACHED DOCUMENT IS A DRAFT COPY WHICH DOES NOT PURPORT TO REFLECT EITHER SPACING OR SIZE OFTYPE AND BECAUSE IT DOES NOT REFLECT APPROPRIATE COLORING FOR EACH LEAF, THE FOLLOWINGINFORMATION IS PROVIDED:

(I) DIMENSIONS. THE OVERALL DIMENSION OF THE UNIFORM TICKET FORM SET WILL BE FOUR AND THREE-FOURTHS INCHES (4 3/4”) IN WIDTH BY TEN INCHES (10’) [N LENGTH. INCLUDED IN THE LENGTH (10”) IS A THREE-FOURTHS INCH (3/4”) PERFORATED TEAR-OFF STRIP AT THE TOP AND A FIVE-EIGHTS INCH (5/8”) PERFORATED TEAROFF STRIP AT THE BOTTOM.

(2) NUMBER OF LEAVES AND COLOR OF PAPER. EXCEPT AS PROVIDED BELOW, ALL UNIFORM TRAFFIC COMPLAINTSSHALL INCLUDE THE FOLLOWING SIX LEAVES WHICH SHALL BE PRINTED ON THE COLOR OF PAPER AS FOLLOWS:

I. COMPLAINT COPY WHITE2. REPORT OF CONVICTION COPY CANARY3. COURT DISPOSITION COPY WHITE4. POLICE RECORD COPY GREEN5. VIOLATOR COPY GOLDEN ROD6. COURT COMMUNICATION COPY BLUE

UPON A WRITTEN REQUEST BY A LAW ENFORCEMENT AGENCY TO THE CLERK OF THE CIRCUIT COURT, THE CHIEFJUDGE OF THAT CIRCUIT MAY, WITH CONCURRENCE OF THE CLERK OF THE CIRCUIT COURT, REQUEST THECONFERENCE OF CHIEF CIRCUIT JUDGES TO AUTHORIZE THE OMISSION OF THE REPORT OF CONVICTION COPYAND/OR COURT DISPOSITION COPY.

(3) FACE OF THE CITATION.(a) ALL PRINTING ON THE FACE OF ALL COPIES OF THE UNIFORM TICKET WILL BE IN BLACK LETTERING,EXCEPT FOR THE FOLLOWING:

(I) THE FOLLOWING WILL BE PRINTED AS A RED BAR WITH WHITELETTERING:(a) TITLES TO EACH BOX(h) TITLE TO THE VEHICLE USE BOX.

(2) THE FOLLOWING WILL BE IN RED PRINT:(a) THE TICKET NUMBER.(b) THE TITLES TO EACH LEAF: COMPLAINT, REPORT OF CONVICTION, COURT

DISPOSITION, POLICE RECORD, VIOLATOR, AND COURT COMMUNICATION.(c) THE PRINTING ACCIDENT TYPE, DRIVER INJURY ONLY. PROPERTY DAMAGE,

PERSONAL INJURY, AND FATAL LOCATED WITHIN THE INCIDENT BOX.(U) THE PRINTING OF THE WORDS COURT APPEARANCE REQUIRED AND NQ COURT

APPEARANCE REQUIRED WITHIN THE COURT PLACE/DATE BOX AND THE BOXOUTLINE AROUND THE WORDS.

(e) THE PRINTING OF THE WORDS IN THE VEHICLE USE SECTION.(fl THE PRINTING OF THE WORDS AND BOX FOR CDL INDICATION.

(b) THE FOLLOWING OPTIONAL INFORMATION MAY BE ADDED TO THE FACE OF EACH LEAF:

(I) THE WORDS “ILLINOIS CITATION AND COMPLAINT-- ILLINOIS STATE POLICE” (OR OTHERAPPROPRIATE WORDING IDENTIFYING THE LAW ENFORCEMENT ENTITY OR MUNICIPALITY, INTHE CASE OF FORMS PRINTED AND ADAPTED FOR USE BY A MUNICIPALITY) MAY BE PRINTEDAT THE TOP OF EACH COPY OF THE FORM.

(2) A BAR CODE MAY BE PLACED ABOVE THE CASE NO. FIELD IN THE COMPLAINT BOX.(3) PRINT THE ADDRESS OF THE COURTHOUSE IN THE COURT PLACE/DATE BOX.

(c) FOR AGENCIES EXEMPT FROM SUPREME COURT RULE 505, THE FOLLOWING TEXT MAY BE PRINTED INTHE COURT PLACE/DATE BOX IN LIEU Of THE COURT DATE. IT IS ACCEPTABLE TO INCORPORATE THECOURT LOCATION ON A SINGLE LINE TO ACCOMMODATE THE TEXT BELOW.

“THE CLERK OF THE COURT WILL NOTIFY YOU OF YOUR COURT DATE WHICH SHALLBE NOT LESS THAN 14 DAYS BUT WITHIN 60 DAYS OF THE DATE OF THE VIOLATIONNOTED ABOVE.”

Revised Effective: May 14, 2014 Page 1

(U) THE PR[NTING OF THE WORDS IN THE BOXES BELOW WILL BE SCREENED SO THEY CAN BE WRITTENOVER:(1) DEFENDANT BOX: LEjJ), (ML) on the NAME LINE: (Street). on the ADDRESS LINE; and

STATE on the DR. LIC. LINE.(2) VIOLATION BOX: NATURE OF OFFENSE(3) COURT PLACE/DATE BOX: CITY AND ZIP, IF NOT PRINTED AS PROVIDED IN (3)(b)(3), ABOVE.

(e) THE PERFORATED TEAR-OFF STRIP AT THE TOP AND AT THE BOTTOM OF THE COMPLAINT COPY OFTHE UNIFORM TICKET SHALL HAVE IMPRINTED, IN BLACK, THE FOLLOWING WORDING:

NOTE; USE SEPARATE CITATIONFOR EACH VIOLATION

ON THE PERFORATED TEAR-OFF STRIPS ON THE OTHER FIVE LEAVES, THE PRINTING OF THIS WORDING IS OPTIONAL.

(4) BACK OF THE CITATION.(a) APPROPRIATE PRINTING ON THE BACK SIDE Of THE POLICE RECORD COPY IS OPTIONAL.

(b) THE PRINTING ON THE BACK SIDE Of THE COMPLAINT, REPORT OF CONVICTION, COURT DISPOSITION,POLICE RECORD, VIOLATOR, AND COURT COMMUNICATION COPIES OF THE UNIFORM TICKET WILLBE IN BLACK LETTERING.

(c) SPECIAL PRINTING INSTRUCTIONS FOR THE BACK SIDE Of THE VIOLATOR AND COURTCOMMUNICATION COPIES Of THE UNIFORM TICKET FOR AGENCIES EXEMPT FROM SUPREME COURTRULE 505:

(I) THE TEXT ON THE BACK SIDE OF THE VIOLATOR COPY OF THE UNIFORM TICKET MAY BEREPLACED WITH THE TEXT PROVIDED IN APPENDIX A.

(2) THE TEXT ON THE BACK SIDE OF THE COURT COMMUNICATION COPY OF THE UNIFORMTICKET MAY BE REPLACED WITH THE TEXT PROVIDED IN APPENDIX B, OR IF THE AGENCYWISHES TO ELIMINATE THE TOP BOX, “AVOID MULTIPLE COURT APPEARANCES,” THE TEXT ONTHE BACK SIDE OF THE COURT COMMUNICATION COPY MAY BE REPLACED WITH THE TEXT INAPPENDIX C.

(5) NO ADDITIONAL MODIFICATIONS TO THE PRINTING OF THE UNIFORM TICKET ARE AUTHORIZED.

Revised Effective: July 1,2014Page 2