| 1. |
In which
Florida County did you get the ticket? |
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| 2. |
In Which
City |
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| 3. |
Enter the
Date of Ticket (mmddyyyy) |
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| 4. |
Enter the
date the Officer wrote on your ticket by which you must comply (mmddyyyy) |
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| 5. |
Enter
your Date of Birth (mmddyyyy) |
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| 6. |
Approximately 2 inches above your signature on the left-hand side of
the ticket you will see three red boxes. Which one did the officer
check? |
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Criminal Violation
Court
Appearance Required
No Court
Appearance Required |
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| 7. |
Is your
license suspended? |
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Yes
No |
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| 8. |
Enter the
total number of tickets the Officer wrote: |
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