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.

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

Speed

IA Code:

State of Iowa

this

Road Work Zone

Weight

Agency

City

Zone

Court Costs

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

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

PLAINTIFF

4. I hereby give my unsecured appearance bond in the amount of

ICIS Sec #:

Subscribed and sworn to me by

at

Fed/Adm Code:

NOTICE: Providing false identification information is a violation of Section 719.1A ofthe Code of Iowa and is punishable as a simple misdemeanor.

Law Enforcement Agency -

Violation

DL State

In the Court at

Located in the county and state aforesaid and did then and there commit the following offense:

Fatal Accident

DL Rest.

Dated

Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not

day of

Zip Code

Form 420001E 1/07

DOB

Local Ord.

Height

require an appearance, report to the above named court on:

Court Appearance Required (805.10)

VS.

Name

DL/State IDViewed?

Race

Sex

The following applies to simple misdemeanors only:

The undersigned states that on or about

Sec #:

Upon a public highway at

CDLReq?

Year

dollars and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense

DL End.

DL#

Address

IOWA UNIFORM CITATION AND COMPLAINT

I swear that the foregoing complaint is true and correct. , Iowa

ICC# Lic. Plate #/REG

I.D. No.

Reference #:

Signature ofDefendant

City of:

Dispatch /Case #:

20

US DOT#

DL Class

State

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.

First

defendant did unlawfully: Operate Motor Vehicle/Boat

State

Scheduled Violation/Fine

Suffix

Criminal SurchargeSerious P.I.

in

Notary/other

Reason:

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.

Civil Damage Assessment Other

County of:

Officer'sSignature

Total Fine/Costs

HazMat End Req?

Officer'sSignature

Non-scheduled Violation

X

ICIS Ord.

at

Defendant, Last

at

COMPLAINT

Pass EndReq?

Co. Enf. Surcharge

Middle

Notary/otherSignature

Dated

P05 4BEC 150228 172709 2

*+P054BEC1502281727092+*

Citation #:

IOWA STATE PATROL - DIST 05

SAC - 81

SAC COUNTY COURTHOUSE 100 NW STATE STREET SUITE 12 SAC CITY IA 50583

06155785GRIFFITH DAVID LEE 5/27/1966YES

W NEthnicity78258-0000SAN ANTONIO TX1004 SILVER KNOLL

5' 10"TX A MALEC NONE

02/28/2015 5:27 PM 2005 WHI CHEVROLET - CHEV

SUB SW

2016 NOIA330ZRN

US 71/130TH AVE

$200.00

$70.00

N/A15FAILURE TO HAVE VALID LICENSE/PERMIT WHILE OPER. MOTOR VEH.

$60.00

321.174 321.174(1)$330.00

104

02/28/2015

02/28/2015

9:30 AM03/23/2015

$465.00

SAC CITY - 6717BECKMAN, B

MARCH, 201501

OTHERIOWA STATE PATROL - DIST 05

NOT GUILTY

Driver's LicenseRecommendation

OTHER DISPOSITION

Other

Susp.

Yr.

BAIL CASH DEPOSIT

DATE: Continued to:

Incarceration in

VERDICT

WARRANT ISSUED

Iowa

DISMISSED

TESTIMONY - JUDGE'S NOTES: (Other Orders)

Revo

Mo.

Signature, person giving bail

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

COST $

ABSTRACT OF COURT RECORD

Address

JURY TRIAL

Days:

DOCKET NO.

REASON

CASE NO.

School

CASE NO.

STATE:

Days

Name

FORFEIT BOND

The court Therefore Enters in Following Order This Date

REASON

Phone

PLEA

LICENSE NO.

NOT GUILTY

Citation #:

GUILTY

Signature, person taking bailDate

DATE:

NO JURY TRIAL orPROCEEDING

GUILTY

DATE:

None

Day

COURT NO.

FINED $ SURCHARGE $ Continued to:

P05 4BEC 150228 172709 2

FILED 03/01/2015 10:35AMCLERK DISTRICT COURTSAC COUNTY IOWA

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.

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

Speed

IA Code:

State of Iowa

this

Road Work Zone

Weight

Agency

City

Zone

Court Costs

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

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

PLAINTIFF

4. I hereby give my unsecured appearance bond in the amount of

ICIS Sec #:

Subscribed and sworn to me by

at

Fed/Adm Code:

NOTICE: Providing false identification information is a violation of Section 719.1A ofthe Code of Iowa and is punishable as a simple misdemeanor.

Law Enforcement Agency -

Violation

DL State

In the Court at

Located in the county and state aforesaid and did then and there commit the following offense:

Fatal Accident

DL Rest.

Dated

Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not

day of

Zip Code

Form 420001E 1/07

DOB

Local Ord.

Height

require an appearance, report to the above named court on:

Court Appearance Required (805.10)

VS.

Name

DL/State IDViewed?

Race

Sex

The following applies to simple misdemeanors only:

The undersigned states that on or about

Sec #:

Upon a public highway at

CDLReq?

Year

dollars and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense

DL End.

DL#

Address

IOWA UNIFORM CITATION AND COMPLAINT

I swear that the foregoing complaint is true and correct. , Iowa

ICC# Lic. Plate #/REG

I.D. No.

Reference #:

Signature ofDefendant

City of:

Dispatch /Case #:

20

US DOT#

DL Class

State

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.

First

defendant did unlawfully: Operate Motor Vehicle/Boat

State

Scheduled Violation/Fine

Suffix

Criminal SurchargeSerious P.I.

in

Notary/other

Reason:

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.

Civil Damage Assessment Other

County of:

Officer'sSignature

Total Fine/Costs

HazMat End Req?

Officer'sSignature

Non-scheduled Violation

X

ICIS Ord.

at

Defendant, Last

at

COMPLAINT

Pass EndReq?

Co. Enf. Surcharge

Middle

Notary/otherSignature

Dated

P05 4BEC 150228 180126 3

*+P054BEC1502281801263+*

Citation #:

IOWA STATE PATROL - DIST 05

SAC - 81

SAC COUNTY COURTHOUSE 100 NW STATE STREET SUITE 12 SAC CITY IA 50583

965RR6322VAZQUEZ BEATRIZ ADRIANA 8/13/1977YES

W NEthnicity50313-0000DES MOINES IA4016 E 10TH ST

4' 10"IA NONE FEMALEC NONE

02/28/2015 6:01 PM 2001 BLU FORD -FORD

EXC SW

2013 NOIA123WLM

US 71/130TH AVE NB 1 N OF D15

5565$40.00

$14.00

N/A15SPEEDING 55 OR < (6 THRU 10 OVER)

$60.00

321.285 321.285-B$114.00

104

02/28/2015

02/28/2015

9:30 AM03/23/2015

$141.00

SAC CITY - 6717BECKMAN, B

MARCH, 201501

OTHERIOWA STATE PATROL - DIST 05

NOT GUILTY

Driver's LicenseRecommendation

OTHER DISPOSITION

Other

Susp.

Yr.

BAIL CASH DEPOSIT

DATE: Continued to:

Incarceration in

VERDICT

WARRANT ISSUED

Iowa

DISMISSED

TESTIMONY - JUDGE'S NOTES: (Other Orders)

Revo

Mo.

Signature, person giving bail

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

COST $

ABSTRACT OF COURT RECORD

Address

JURY TRIAL

Days:

DOCKET NO.

REASON

CASE NO.

School

CASE NO.

STATE:

Days

Name

FORFEIT BOND

The court Therefore Enters in Following Order This Date

REASON

Phone

PLEA

LICENSE NO.

NOT GUILTY

Citation #:

GUILTY

Signature, person taking bailDate

DATE:

NO JURY TRIAL orPROCEEDING

GUILTY

DATE:

None

Day

COURT NO.

FINED $ SURCHARGE $ Continued to:

P05 4BEC 150228 180126 3

FILED 03/01/2015 10:35AMCLERK DISTRICT COURTSAC COUNTY IOWA