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SCR 37A Uniform Citation

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					Form 37.A Uniform Citation Abstract of Court Record

9945678292
UNIFORM CITATION
STATE OF MISSOURI IN THE CIRCUIT COURT OF COURT ADDRESS (Street, City, Zip) DIVISION COUNTY COUNTY

COURT DATE

COURT TIME

AM PM

COURT PHONE NO.

(

)
UPON/AT OR NEAR (LOCATION)

I, KNOWING THAT FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY LAW, STATE THAT I HAVE PROBABLE CAUSE TO BELIEVE THAT:
ON/ABOUT (Date) AT TIME HRS HWY CLASS

WITHIN CITY/COUNTY AND STATE AFORESAID,
NAME (LAST, FIRST, MIDDLE)

STREET ADDRESS

CITY

STATE

ZIP CODE

DATE OF BIRTH

AGE

RACE

SEX

HEIGHT

WEIGHT

DRIVER’S LIC. NO.

CDL: YES

STATE

NO

LEAVE THIS LINE BLANK
EMPLOYER

ADDRESS (Street, City, State, Zip)

DID UNLAWFULLY
V E H I C L E

OPERATE / DRIVE MAKE

PARK MODEL

C.M.V. STYLE

WITH HAZ. MAT COLOR

YEAR

REGISTERED WEIGHT

L I C

NUMBER

STATE

YEAR

DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE. THE FACTS SUPPORTING THIS BELIEF ARE AS FOLLOWS:

Subject taken into custody. (Complete “For Issuance of a Warrant” section on reverse side.)
DRIVING
MPH

POSTED SPEED LIMIT
MPH

DETECTION METHOD STATIONARY RADAR WATCH (AIR) WATCH (GROUND) PACE OTHER MOVING RADAR CHARGE CODE:

IN VIOLATION OF:

RSMo ORD.

IN FATAL ACCIDENT CHARGE CODE IN ACCIDENT DWI/BAC BADGE TRP/ZONE DATE

SEAT BELT VIOLATION: OFFICER

ORD. _______________ RSMo

ON INFORMATION, UNDERSIGNED PROSECUTOR CHARGES THE DEFENDANT AND INFORMS THE COURT THAT ABOVE FACTS ARE TRUE AND PUNISHABLE BY : PROSECUTOR’S SIGNATURE

RSMo ORD.

DATE

I promise to dispose of the charges of which I am accused through court appearance or prepayment of fine and court costs. SIGNATURE

DR. LIC. POSTED

X

YES NO

Reverse Side, Abstract of Court Record
FOR ISSUANCE OF A WARRANT COMPLETE AT LEAST ONE OF THE FOLLOWING: Defendant will not appear because

Defendant poses a danger to the victim or the community/other person because

VIOL CODE

DESCRIPTION CODE

SENT CODE

LIC SURRENDERED

DOR USE ONLY

ADD POINTS

DOR MICROFILM NUMBER

COURT ORI MO COURT CASE NUMBER

COURT NAME (SPECIFY COUNTY, DIVISION)

DATE FILED

DATE OF SENTENCE (CONVICTION, SIS)

CHARGE AS DISPOSED FELONY MISDEMEANOR INFRACTION RSMo ORD FINE ORDERED $ SUSPENDED IMPOSITION OF SENTENCE (SIS) PROBATION TERM: DAYS OF CONFINMENT ORDERED

MO CHARGE CODE

DESCRIPTION OF OFFENSE

SEAT BELT CONVICTION $ FINE

SENTENCE SUSPENDED (SES) DAYS SUSPENDED ______________ FINE SUSPENDED _______________

MANDATORY INSURANCE: ORDER OF SUPERVISION DO NOT ASSESS POINTS ORDER OF SUSPENSION ASSESS POINTS YES NO

DRIVER IMPROVEMENT PROGRAM (IN LIEU OF POINT ASSESSMENT) LICENSE SURRENDERED AT CONVICTION YES NO

PROPERTY DAMAGE/PERSONAL INJURY RESULTED FROM VIOLATION, ASSESS TWO ADDITIONAL POINTS DEFENDANT REPRESENTED BY COUNSEL YES NO DEFENDANT WAIVED RIGHT TO COUNSEL IN WRITING YES NO

BOND FORFEITURE PREVIOUSLY SENT TO DOR YES NAME OF JUDGE NO

LAWYER JUDGE YES NO

REMARKS:

I CERTIFY THIS TO BE A TRUE ABSTRACT OF RECORD IN THIS CASE
NAME & TITLE

Form 37.A Uniform Citation Information

9945678292
UNIFORM CITATION
STATE OF MISSOURI IN THE CIRCUIT COURT OF COURT ADDRESS (Street, City, Zip) DIVISION COUNTY COUNTY

COURT DATE

COURT TIME

AM PM

COURT PHONE NO.

(

)
UPON/AT OR NEAR (LOCATION)

I, KNOWING THAT FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY LAW, STATE THAT I HAVE PROBABLE CAUSE TO BELIEVE THAT:
ON/ABOUT (Date) AT TIME HRS HWY CLASS

WITHIN CITY/COUNTY AND STATE AFORESAID,
NAME (LAST, FIRST, MIDDLE)

STREET ADDRESS

CITY

STATE

ZIP CODE

DATE OF BIRTH

AGE

RACE

SEX

HEIGHT

WEIGHT

DRIVER’S LIC. NO.

CDL: YES

STATE

NO

LEAVE THIS LINE BLANK
EMPLOYER

ADDRESS (Street, City, State, Zip)

DID UNLAWFULLY
V E H I C L E

OPERATE / DRIVE MAKE

PARK MODEL

C.M.V. STYLE

WITH HAZ. MAT COLOR

YEAR

REGISTERED WEIGHT

L I C

NUMBER

STATE

YEAR

DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE. THE FACTS SUPPORTING THIS BELIEF ARE AS FOLLOWS:

Subject taken into custody. (Complete “For Issuance of a Warrant” section on reverse side.)
DRIVING
MPH

POSTED SPEED LIMIT
MPH

DETECTION METHOD STATIONARY RADAR WATCH (AIR) WATCH (GROUND) PACE OTHER MOVING RADAR CHARGE CODE:

IN VIOLATION OF:

RSMo ORD.

IN FATAL ACCIDENT CHARGE CODE IN ACCIDENT DWI/BAC BADGE TRP/ZONE DATE

SEAT BELT VIOLATION: OFFICER

ORD. _______________ RSMo

ON INFORMATION, UNDERSIGNED PROSECUTOR CHARGES THE DEFENDANT AND INFORMS THE COURT THAT ABOVE FACTS ARE TRUE AND PUNISHABLE BY : PROSECUTOR’S SIGNATURE

RSMo ORD.

DATE

I promise to dispose of the charges of which I am accused through court appearance or prepayment of fine and court costs. SIGNATURE

DR. LIC. POSTED

X

YES NO

Reverse Side, Information

FOR COURT USE ONLY

BOND AMOUNT $ BOND EXPIRES DATE TIME AM PM AM PM AM PM COURT ORI MO COURT CASE NUMBER

BOND POSTED BY BOND FORFEITURE NUMBER TFRD TO REFUND $ REASON CONTINUED

COURT NAME (SPECIFY COUNTY, DIVISION)

DATE FILED

DATE OF SENTENCE (CONVICTION, SIS)

CHARGE AS DISPOSED FELONY MISDEMEANOR INFRACTION RSMo ORD FINE ORDERED $ SUSPENDED IMPOSITION OF SENTENCE (SIS) PROBATION TERM: DAYS OF CONFINMENT ORDERED

MO CHARGE CODE

DESCRIPTION OF OFFENSE

SEAT BELT CONVICTION $ FINE

SENTENCE SUSPENDED (SES) DAYS SUSPENDED ______________ FINE SUSPENDED _______________

MANDATORY INSURANCE: ORDER OF SUPERVISION DO NOT ASSESS POINTS ORDER OF SUSPENSION ASSESS POINTS YES NO

DRIVER IMPROVEMENT PROGRAM (IN LIEU OF POINT ASSESSMENT) LICENSE SURRENDERED AT CONVICTION YES NO

PROPERTY DAMAGE/PERSONAL INJURY RESULTED FROM VIOLATION, ASSESS TWO ADDITIONAL POINTS DEFENDANT REPRESENTED BY COUNSEL YES NO DEFENDANT WAIVED RIGHT TO COUNSEL IN WRITING YES NO

BOND FORFEITURE PREVIOUSLY SENT TO DOR YES NAME OF JUDGE NO

LAWYER JUDGE YES NO

REMARKS

PLEA GUILTY NOT GUILTY

FINDING GUILTY NOT GUILTY

COURT COSTS $

Form 37.A Uniform Citation Arrest Record

9945678292
UNIFORM CITATION
STATE OF MISSOURI IN THE CIRCUIT COURT OF COURT ADDRESS (Street, City, Zip) DIVISION COUNTY COUNTY

COURT DATE

COURT TIME

AM PM

COURT PHONE NO.

(

)
UPON/AT OR NEAR (LOCATION)

I, KNOWING THAT FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY LAW, STATE THAT I HAVE PROBABLE CAUSE TO BELIEVE THAT:
ON/ABOUT (Date) AT TIME HRS HWY CLASS

WITHIN CITY/COUNTY AND STATE AFORESAID,
NAME (LAST, FIRST, MIDDLE)

STREET ADDRESS

CITY

STATE

ZIP CODE

DATE OF BIRTH

AGE

RACE

SEX

HEIGHT

WEIGHT

DRIVER’S LIC. NO.

CDL: YES

STATE

NO

LEAVE THIS LINE BLANK
EMPLOYER

ADDRESS (Street, City, State, Zip)

DID UNLAWFULLY
V E H I C L E

OPERATE / DRIVE MAKE

PARK MODEL

C.M.V. STYLE

WITH HAZ. MAT COLOR

YEAR

REGISTERED WEIGHT

L I C

NUMBER

STATE

YEAR

DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE. THE FACTS SUPPORTING THIS BELIEF ARE AS FOLLOWS:

Subject taken into custody. (Complete “For Issuance of a Warrant” section on reverse side.)
DRIVING
MPH

POSTED SPEED LIMIT
MPH

DETECTION METHOD STATIONARY RADAR WATCH (AIR) WATCH (GROUND) PACE OTHER MOVING RADAR CHARGE CODE:

IN VIOLATION OF:

RSMo ORD.

IN FATAL ACCIDENT CHARGE CODE IN ACCIDENT DWI/BAC BADGE TRP/ZONE DATE

SEAT BELT VIOLATION: OFFICER

ORD. _______________ RSMo

ON INFORMATION, UNDERSIGNED PROSECUTOR CHARGES THE DEFENDANT AND INFORMS THE COURT THAT ABOVE FACTS ARE TRUE AND PUNISHABLE BY : PROSECUTOR’S SIGNATURE

RSMo ORD.

DATE

I promise to dispose of the charges of which I am accused through court appearance or prepayment of fine and court costs. SIGNATURE

DR. LIC. POSTED

X

YES NO

Reverse Side, Arrest Record
NAME OF JUDGE DISPOSITION

DATE

Form 37.A Uniform Citation – Violator’s Copy

9945678292
UNIFORM CITATION
STATE OF MISSOURI IN THE CIRCUIT COURT OF COURT ADDRESS (Street, City, Zip) DIVISION COUNTY COUNTY

COURT DATE

COURT TIME

AM PM

COURT PHONE NO.

(

)
UPON/AT OR NEAR (LOCATION)

I, KNOWING THAT FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY LAW, STATE THAT I HAVE PROBABLE CAUSE TO BELIEVE THAT:
ON/ABOUT (Date) AT TIME HRS HWY CLASS

WITHIN CITY/COUNTY AND STATE AFORESAID,
NAME (LAST, FIRST, MIDDLE)

STREET ADDRESS

CITY

STATE

ZIP CODE

DATE OF BIRTH

AGE

RACE

SEX

HEIGHT

WEIGHT

DRIVER’S LIC. NO.

CDL: YES

STATE

NO

LEAVE THIS LINE BLANK
EMPLOYER

ADDRESS (Street, City, State, Zip)

DID UNLAWFULLY
V E H I C L E

OPERATE / DRIVE MAKE

PARK MODEL

C.M.V. STYLE

WITH HAZ. MAT COLOR

YEAR

REGISTERED WEIGHT

L I C

NUMBER

STATE

YEAR

DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE. THE FACTS SUPPORTING THIS BELIEF ARE AS FOLLOWS:

Subject taken into custody. (Complete “For Issuance of a Warrant” section on reverse side.)
DRIVING
MPH

POSTED SPEED LIMIT
MPH

DETECTION METHOD STATIONARY RADAR WATCH (AIR) WATCH (GROUND) PACE OTHER MOVING RADAR CHARGE CODE:

IN VIOLATION OF:

RSMo ORD.

IN FATAL ACCIDENT CHARGE CODE IN ACCIDENT DWI/BAC BADGE TRP/ZONE DATE

SEAT BELT VIOLATION: OFFICER

ORD. _______________ RSMo

ON INFORMATION, UNDERSIGNED PROSECUTOR CHARGES THE DEFENDANT AND INFORMS THE COURT THAT ABOVE FACTS ARE TRUE AND PUNISHABLE BY : PROSECUTOR’S SIGNATURE

RSMo ORD.

DATE

I promise to dispose of the charges of which I am accused through court appearance or prepayment of fine and court costs. SIGNATURE

DR. LIC. POSTED

X

YES NO

Reverse Side, Violator’s Copy YOUR FAILURE TO APPEAR IN COURT AT THE TIME SPECIFIED ON THIS CITATION OR OTHERWISE RESPOND TO THE CITATION AS DIRECTED MAY RESULT IN THE SUSPENSION OF YOUR DRIVER’S LICENSE AND DRIVING PRIVILEGE AND MAY RESULT IN A WARRANT BEING ISSUED FOR YOUR ARREST.

APPEARANCE, PLEA OF GUILTY AND WAIVER – ONLY FOR OFFENSES NOT REQUIRING A COURT APPEARANCE.

I, the undersigned, do hereby enter my appearance on the offense specified on the other side of this citation. I have been informed of my right to a trial, that my signature to this plea of guilty will have the same force and effect as a judgment of court, and that this record will be sent to the licensing authority of this state. I do hereby plead guilty to this offense as specified, waive my right to a hearing by the court, and agree to pay the penalty prescribed for my offense.
DEFENDANT’S SIGNATURE

STREET ADDRESS

CITY, STATE, ZIP

DRIVER’S LICENSE NUMBER

Form 37.A Uniform Citation – Officer Record

9945678292
UNIFORM CITATION
STATE OF MISSOURI IN THE CIRCUIT COURT OF COURT ADDRESS (Street, City, Zip) DIVISION COUNTY COUNTY

COURT DATE

COURT TIME

AM PM

COURT PHONE NO.

(

)
UPON/AT OR NEAR (LOCATION)

I, KNOWING THAT FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY LAW, STATE THAT I HAVE PROBABLE CAUSE TO BELIEVE THAT:
ON/ABOUT (Date) AT TIME HRS HWY CLASS

WITHIN CITY/COUNTY AND STATE AFORESAID,
NAME (LAST, FIRST, MIDDLE)

STREET ADDRESS

CITY

STATE

ZIP CODE

DATE OF BIRTH

AGE

RACE

SEX

HEIGHT

WEIGHT

DRIVER’S LIC. NO.

CDL: YES

STATE

NO

LEAVE THIS LINE BLANK
EMPLOYER

ADDRESS (Street, City, State, Zip)

DID UNLAWFULLY
V E H I C L E

OPERATE / DRIVE MAKE

PARK MODEL

C.M.V. STYLE

WITH HAZ. MAT COLOR

YEAR

REGISTERED WEIGHT

L I C

NUMBER

STATE

YEAR

DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE. THE FACTS SUPPORTING THIS BELIEF ARE AS FOLLOWS:

Subject taken into custody. (Complete “For Issuance of a Warrant” section on reverse side.)
DRIVING
MPH

POSTED SPEED LIMIT
MPH

DETECTION METHOD STATIONARY RADAR WATCH (AIR) WATCH (GROUND) PACE OTHER MOVING RADAR CHARGE CODE:

IN VIOLATION OF:

RSMo ORD.

IN FATAL ACCIDENT CHARGE CODE IN ACCIDENT DWI/BAC BADGE TRP/ZONE DATE

SEAT BELT VIOLATION: OFFICER

ORD. _______________ RSMo

ON INFORMATION, UNDERSIGNED PROSECUTOR CHARGES THE DEFENDANT AND INFORMS THE COURT THAT ABOVE FACTS ARE TRUE AND PUNISHABLE BY : PROSECUTOR’S SIGNATURE

RSMo ORD.

DATE

I promise to dispose of the charges of which I am accused through court appearance or prepayment of fine and court costs. SIGNATURE

DR. LIC. POSTED

X

YES NO

Reverse Side, Officer Record

DISOBEYED SIGNAL (WHEN LIGHT TURNED RED) DISOBEYED STOP SIGN IMPROPER TURN

PAST MIDDLE OF INTERSECTION MIDDLE OF INTERSECTION STOPPED WRONG PLACE NO SIGNAL NOT REACHED INTERSECTION WALK SPEED FASTER

INTO WRONG LANE FROM WRONG LANE AT INTERSECTION ON HILL ON CURVE PROHIBITED ON RIGHT BETWEEN TRAF CUT IN

LEFT

RIGHT

“U”

CUT CORNER

IMPROPER PASSING IMPROPER LANE USE

WRONG SIDE OF PAVEMENT WRONG LANE LANE STRADDLING

SLIPPERY PAVEMENT RAIN SNOW ICE

CAUSED PERSON TO DODGE PEDESTRIAN OPERATOR AREA RESIDENTIAL RURAL OTHER PEDESTRIAN 6-LANE DIVIDED RIGHT ANGLE HIT FIXED OBJECT JUST MISSED ACCIDENT

VISABILITY NIGHT RAIN/SNOW FOG CROSS 3-LANE

SCHOOL SAME DIRECTION 4-LANE VEHICLE REAR-END

BUSINESS ONCOMING 4-LANE DIVIDED INTERSECTION RAN OFF ROAD

OTHER TRAFFIC PRESENT ROAD TYPE: IN ACCIDENT 2-LANE

PEDESTRIAN HEADS ON SIDESWIPE

NAMES AND ADDRESSES OF WITNESSES

REPORT OF ACTION IN CASE

NON CONVICTION DISPOSITION DATA ONLY COURT ORI COURT CASE NUMBER

DATE OF HEARING

DEF. REP. BY COUNSEL

DEF. WAIVED COUNSEL

YES

NO

YES

NO

COURT FINDINGS (NOT GUILTY, SIS, NOLLE PROSSED, DISMISSED, ETC.)


				
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