Continuation Of Notice To Appear Template
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1
2
3CONTINUATION OF NOTICE TO APPEAR
(Face of Violator’s Copy)
(
)
Name of Agency and Jurisdiction
MISDEMEANOR
c
CONTINUATION OF NOTICE
c
Traffic
c
Nontraffic
(Citation No.)
TO APPEAR
Date
Time
AM
Day of Week
Case No.
/
/
S M T W T F S
PM
1.
Name (First, Middle, Last)
2.
Veh. Lic. No. or VIN
State
3.
Correctable Violation (Veh. Code, § 40610)
Misdemeanor or
Yes
No
Code and Section
Description
Infraction (Circle)
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4.c
M
I
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5.c
M
I
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6.c
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I
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7.c
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I
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8.c
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I
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9.c
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I
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10.c
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I
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11.c
M
I
c
12.c
M
I
c
13.c
M
I
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14.c
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I
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15.c
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16.c
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I
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17.c
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18.c
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19.c
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20.c
M
I
Violations not committed in my presence, declared on information and belief.
21.c
I declare under penalty of perjury under the laws of the State of California the foregoing is true and
correct, and a continuation of the enforcement document noted.
22.
Arresting or Citing Officer
Serial No.
/
/
23.
Date
Name of Arresting Officer, if different from Citing Officer
Serial No.
WITHOUT ADMITTING GUILT, I PROMISE TO APPEAR AT THE TIME AND PLACE
INDICATED.
24.
X Signature
Judicial Council of California Form
SEE REVERSE
Rev. 01-01-04 (Veh. Code, §§ 40500(b), 40513(b), 40522, 40600; Pen. Code, § 853.9)
TR-106
Shaded areas on the form indicate spaces subject
to modification for local or agency requirements.
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