01/07

DEFENDANT'S COPY (FURNISH,TO COURT)'

IOWA U N I F O R M CITATION A N D C O M P L A I N T

SAG eWV FQ'uiGE DEPT

PTI .Stale of lowa County, of;.

SAC . SI SAC CITY : . . SAC CO. COURTHOUSE mt h ec o u r t a, 100 N.W. STATE ST, STE. 12 SACfMTV, IA 50533
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The undersigned states that on or about **/ / <3. / fl^> at / / & - PM defendant did unlawfully: . "*? * . . - \. '- . ' , , V > : . Operate Motor Vehicle/Boat (describe) /"<-"' C t l t- * s / :
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Upon a public highway at '^ ^ yts ~ Located in the county and state aforesaid and did.then and there commit the following offense: . Qrfaffic Navigation Snowmobile/ATV O Fish-Game Parks Tobacco S c h e d . Vidiation/Fine' Criminal Surcharge Co. Enf. Surcharge .
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Court Appearance Required ( 8 0 5 . 1 0 ) . . "son: Serious P.I I I Fatal Accident

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Speed >;?>X--' in ~ "~~ Zone Sec . Fed/Adm. Code

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Mo. Day Yr. ^ y Officer's Signature I.D. No. C o u r t Date: If you must appear in court or if you "choose to appear to a n s w e r to a charge which does not require an appearance, report to the above named court on

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N O T I C E : Providing false information is a violation of Section 719.3 of the C o d e of lowa and is punishable as an aggravated misdemeanor. You hereby are given notice that within a reasonable time but no later than the date scheduled for your initial appearance a citation/complaint sworn under oath will be filed with the distnct court clerk of the county in which the citation was issued.

My signature below is not a plea of guilty, but acknowledges all ofthe following:
1. 1 hereby swear and affirm that the information provided by me on this citation is true under penalty of providing false information. 2. I promise to appear in said court at said time and place, or I will comply with the provision o n the top of the reverse side of the citation. ^ The following applies to simple misdemeanors only: - i r " j * ^ .-^ ^ 3. 1 hereby give my unsecured appearance bond in the amount df / 7 / f O rinHar* and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense 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 costs. /' /
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E-FILED 2013 SEP 03 1:20 AM SAC - CLERK OF DISTRICT COURT

E-FILED 2013 SEP 03 1:20 AM SAC - CLERK OF DISTRICT COURT