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Name: Date of Birth:
A.K.A.: Priors:
Address: Warrants: No
City/State/Zip:  
Name:  
Agency:  
File Date: Section #:
Ticket Number: Degree:
Date: Points:
Time: BMV Offense Code:
Description:  
Date: Mandatory:
Time: Attorney Name:
Type:  
Summons Issued: Status Date:
  Status Code:
  ITN Number:
Ins. Proof Shown: Haz. Material:
OL State: Comm. Violation:
OL Type: DUI Test Refused:
Plate Number: DUI Test Type:
  DUI Blood Test:
 
Amount Owed
Paid to Date
Balance Due
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
 
$0.00
$0.00
$0.00
Total Owed:
$ 0.00
Last Payment:
Paid to Date:
$ 0.00
Payment Type:
Balance Due:
$ 0.00
Paid By:
Waiver Amount:
$ 0.00
Receipt #:
Bond Amount:
$ 0.00
 
Bond Refunded:
$ 0.00
 
Bond Available:
$ 0.00
 
Disposition Date: Fine Amount:
$ 0.00
Defendant's Plea: Fine Suspended:
$ 0.00
Defendant Found: Costs Amount:
$ 0.00
OL Susp. From: Costs Suspended:
$ 0.00
OL Susp. To: Jail Time:
  Jail Suspended:
Disposition: