MASSACHUSETTS UNIFORM CITATION R Sample...address city/town plate type offense date (mm/dd/yy) location of offense (include #, st, hwy, city or town) a. chap/ sec/sub crim civil crim

NOTICE TO VIOLATORSEE REVERSE SIDEFOR INSTRUCTIONS

NOTICE TO OFFICERENTER ASSESSMENT $AND TOTAL DUE $ ONLY

IF YOU CHECK“ALL CIVIL INFRACTIONS”.ENTER COURT ADDRESS

BELOW ONLY IF YOU CHECK“CRIMINAL APPLICATION”.

MASSACHUSETTS UNIFORM CITATION

VIO

LAT

OR

CO

PY

TYPE OF CITATIONDATE WRITTEN (MM/DD/YY)

MOTOR VEHICLE LICENSE NO. OF VIOLATOR STATE CLASS RACE SEX

(Initial)

STATE ZIP

NON-INVENTORY MV SEARCH

BIRTH DATE (MM/DD/YY)CODE

YES NO CDL LICENSE

YES NOVIOLATOR NAME (Last) (First)

ADDRESS CITY / TOWN

PLATE TYPE

OFFENSE DATE (MM/DD/YY) LOCATION OF OFFENSE (include #, st, hwy, city or town)

A. CHAP/ SEC / SUB CRIMCIVIL

CRIMCIVIL

CRIMCIVIL

CIVILMPHINA

MPHZONE

POSTEDNOT POSTEDLIDAR

CLOCKEDRADARESTIMATED

DESCRIPTION OF OFFENSE

B.

C.

OFFICERCHECKONE ONLY

X

X

OFFICER CERTIFIES IN HAND TO VIOL.

ALL CIVIL INFRACTIONS(See instruction A on back)

CRIMINAL APPLICATION(See instruction B on back)

WARNING(No action required)

ARREST

MAILED TO VIOL. IN HAND TO VIOLATOR’S AGENT

AGENT NAME

AGENT’S LICENSE NUMBER & STATEVIOLATOR/ AGENT ACKNOWLEDGES RECEIPT OF CITATION

D. SPEEDING

90 /17 90/18

VEHICLE REGISTRATION NO. STATE YEAR CDL VEHICLE

YES NO

16+ PASSENGERS

YES NO

CRASH

YES NO

MAKE AND TYPE

ASSESSMENT

TOTAL DUE

COURT ADDRESS

$

$

$

$

$

TIME OF OFFENSE AM

PM

COLOR

AGENCY CODE OFFICER I.D. NUMBER COURT CODE OPERATOR OWNER

PASSENGER BICYCLISTR

SPEEDING ASSESSMENTS INCLUDE A $50 HEAD INJURY SURCHARGE

VIOLATOR

MV

OFFENSE

(S)

PLACARDED HAZMAT

YES NO

recyclable

1

“PR

ES

S H

AR

D - You are m

aking 5 copies.”

Mass Uniform Citation 2012 1/10/12 1:53 PM Page 1

Sample

INSTRUCTION A (ALL CIVIL INFRACTIONS)

INSTRUCTION B (CRIMINAL APPLICATION)

If “ALL CIVIL INFRACTIONS”is checked on the front,

all the violations with w

hich you are charged are civil infractions.To avoid late fees and possible suspension/revocation of your license or registration,

you m

ust either pay this citation in full or request a court hearing WITHIN 20 DAYS of the date of offense.To

pay your citation in full,check off Box 1 (I W

ISH TO PAY THIS CITATION).To request a court hearing,

check off Box 2 (I REQUEST A COURT HEARING).Read the instructions and sign below

.If you fail to

pay this citation in full or fail to request a hearing and pay the $25 Court Filing Fee within 20 days,

you w

ill lose your right to a hearing; you will have to pay substantial late charges,

and your license/right to operate or registration w

ill be suspended/revoked.

Mail:

Make

your checkpayable

to MassDOT,

write the citation num

ber,your license num

ber and state ofissuance on the front of the check.

DO NOT MAIL CASH.

Place your payment and this citation in

the envelope provided and m

ail it to the address below.Rem

ember to check off the Paym

ent box on the Frontof the Envelope.

I WISH

TO PAYTHIS

CITATION.I am

payingthe “TOTAL DUE”

shown as a final disposition

of this citation and I am w

aivingm

y right to a civil hearingbefore a court m

agistrate.I under-

standthat such paym

entis an adm

ission of responsibility for all infractionsand any Registry

action under the law,

and may affect m

y auto insuranceprem

ium.

I also understand that such paym

ent is not an admission of guilt,

responsibility,or negligence

in any other criminal

or civil proceeding.

I REQUEST A COURT HEARING.I deny that i am

responsible for the civil infraction(s) charged on this citation,

and I request a civil hearing before a court magistrate.

I understand that I must

pay a $25 court filing fee before the court will notify m

e by mail of the date and tim

e of the hear-ing and I m

ust appear in court on the scheduled date and time.

Place your $25 court filing fee and this citation in the envelope provided and m

ail it to the address below.

Check off the hear-ing request/filing fee box on the front of the envelope.

To pay your court filing fee: Make your check payable to M

assDOT,w

rite the citation number,

your license num

ber and state of issuance on the front of the check.DO NOT M

AIL CASH.Place your $25

court filing fee and this citation in the envelope provided and mail it to the address below

.Rem

ember to

check off the Hearing Request/Filing Fee box on the front of the envelope.

Report Address Changes: All correspondence will be m

ailed to the address on file at the RMV.

It is im

portant to report address changes.I certify that I entered my correct m

ailing address on the front of the envelope and authorize the RM

V to make any necessary changes.

X

On-line at ww

w.m

ass.gov/rmv.You w

ill need your citation number,credit card or check.

You can pay your citation the following w

ays:

Phone: 617-351-4500 (from area codes 617,857,781,and 339) or 800-858-3926 from

all other MA area

codes.Monday - Friday from

9am - 5pm

.

Signature of ViolatorDate

XSIGNATURE OF VIOLATOR

DATE

XSignature of ViolatorDate

Mail Paym

ent For Citation Or Court Hearing Request And Court Filing Fee To:Citation Processing

CenterBox

55890,Boston,MA

02205-5890

If “CRIMINAL APPLICATION”

is checked you will be granted a hearing as to w

hether a criminal com

plaintshould issue againstyou

ifyou sign below and return this citationW

ITHIN 4 DAYS to the Clerk-Magistrate

of the court named on

the front of this citation.Any accompanying civil infractions w

ill be determined

during the criminal proceedings and cannot be paid in advance.

ADDRESS CHANGES MUST BE REPORTED TO

BOTHTHE

REGISTRY OFM

OTOR VEHICLES ANDTO

THE COURT.

12


Sample

COURT ADDRESS

JUDGMENT

DOCKETNUMBER

JUDGMENT DATE COMMENT

MASSACHUSETTS UNIFORM CITATION TYPE OF CITATION


(Initial)

STATE ZIP


CODEYES NO

CDL LICENSE


ADDRESS CITY / TOWN

PLATE TYPE

LOCATION OF OFFENSE (include #, st, hwy, city or town)


CRIMCIVIL

CRIMCIVIL

CIVILMPHINA

MPHZONE




B.

C.


X

X





ARREST


AGENT NAME


D. SPEEDING

90 /17 90/18


YES NO

CRASH

YES NOASSESSMENT

TOTAL DUE

COURT ADDRESS

$

$

$

$

$

TIME OF OFFENSE AM

PM

AGENCY CODE OFFICER I.D. NUMBER COURT CODE R


VIOLATOR

MV

OFFENSE

(S)

recyclable

1

“PR

ES

S H

AR

D - You are m

aking 5 copies.”RM

V C

OP

Y(I

F C

IVIL

) O

R C

OU

RT

CO

PY

(IF

CR

IM.)

DATE WRITTEN (MM/DD/YY)

BIRTH DATE (MM/DD/YY)

OFFENSE DATE (MM/DD/YY)

16+ PASSENGERS

YES NO

PLACARDED HAZMAT

YES NO

OPERATOR OWNER

PASSENGER BICYCLIST

MAKE AND TYPE COLOR


Sample

COURTRECORDRECORD OFCLERKHEARINGON COMPLAINTAPPLICATION

OTHERCOURTACTIONSACTION, JUDGE, ETC.

OFFENSE

DATE

DATECLERKRESULT

A.

B.

C.

D.


Sample

AG

EN

CY

CO

PY

(IF

CIV

IL)

OR

CO

UR

TC

OP

Y(I

F C

RIM

.)

COURT ADDRESS

JUDGMENT

DOCKETNUMBER

JUDGMENT DATE COMMENT



(Initial)

STATE ZIP


CODEYES NO

CDL LICENSE


ADDRESS CITY / TOWN

PLATE TYPE



CRIMCIVIL

CRIMCIVIL

CIVILMPHINA

MPHZONE




B.

C.


X

X





ARREST


AGENT NAME


D. SPEEDING

90 /17 90/18


YES NO

CRASH

YES NOASSESSMENT

TOTAL DUE

COURT ADDRESS

$

$

$

$

$

TIME OF OFFENSE AM

PM



VIOLATOR

MV

OFFENSE

(S)

recyclable

1

“PR

ES

S H

AR

D - You are m

aking 5 copies.”




16+ PASSENGERS

YES NO

PLACARDED HAZMAT

YES NO

OPERATOR OWNER

PASSENGER BICYCLIST

MAKE AND TYPE COLOR


Sample

IC

ER

TIFYTH

ATT

HE

INF

OR

MAT

ION

RE

LATIN

GTO

“JUD

GM

EN

T,”“JU

DG

ME

NT

DAT

E”

AN

D“C

OM

ME

NT

”,E

NT

ER

ED

ON

T

HE

R

EV

ER

SE

SID

EO

F

TH

ISC

ITATION

,ISTR

UE

AN

DC

OR

RE

CT.

AP

PR

OV

ED

CO

DE

SF

OR

US

EIN

EN

TE

RIN

GJU

DG

ME

NT

INFO

RM

ATION

ON

TH

ISA

BS

TRA

CT

CO

UR

TVA

LIDAT

ION

STA

MP

G =

G

uiltyN

G =

N

ot Guilty

R =

R

esponsibleN

R =

N

ot Responsible

DL

=

Delinquent

ND

=

Not D

elinquentF

I =

Filed

(only byjudge,w

hereallow

edby law

)

DF

=

D

efaultD

R

=

DefaultR

emoved

DI

=

Dism

issedC

W

=

Continued

WithoutF

indingN

P=

N

olleP

rosseC

D

=

Com

plaintDenied


Sample

AG

EN

CY

CO

PY



(Initial)

STATE ZIP


CODEYES NO

CDL LICENSE


ADDRESS CITY / TOWN

PLATE TYPE



CRIMCIVIL

CRIMCIVIL

CIVILMPHINA

MPHZONE




B.

C.


X

X





ARREST


AGENT NAME


D. SPEEDING

90 /17 90/18


YES NO

CRASH

YES NOASSESSMENT

TOTAL DUE

COURT ADDRESS

$

$

$

$

$

TIME OF OFFENSE AM

PM



VIOLATOR

MV

OFFENSE

(S)

recyclable

1

“PR

ES

S H

AR

D - You are m

aking 5 copies.”




16+ PASSENGERS

YES NO

PLACARDED HAZMAT

YES NO

OPERATOR OWNER

PASSENGER BICYCLIST

MAKE AND TYPE COLOR


Sample

OFFIC

ER

’S N

OT

ES

FOR

TE

ST

IFYIN

GIN

CO

UR

T

Please note

factsand

circumstances

in additionto

tho

sech

ecke

do

nthe face

of the citation, that is:

(1) any specificaction of

violator w

hich

increased the hazard of the violation;(2)

where

violation observedand w

here contactm

ade;(3)

totaldistance

traveled during pursuit;

(4) statem

ents by violator and general

attitu

de

.

WE

AT

HE

R

NO

.LAN

ES

:

CLE

AR

CLO

UD

Y

RA

IN

SN

OW

FO

G

SLE

ET

HIG

HW

AY

DR

Y

WE

T

MU

DD

Y

SN

OW

Y

ICY

DIV

IDE

D

TR

AF

FIC

LIGH

T

ME

DIU

M

HE

AV

Y

LIGH

T

DA

YLIG

HT

DA

RK

NE

SS

DA

WN

DU

SK


Sample

OF

FIC

ER

C

OP

Y



(Initial)

STATE ZIP


CODEYES NO

CDL LICENSE


ADDRESS CITY / TOWN

PLATE TYPE



CRIMCIVIL

CRIMCIVIL

CIVILMPHINA

MPHZONE




B.

C.


X

X





ARREST


AGENT NAME


D. SPEEDING

90 /17 90/18


YES NO

CRASH

YES NOASSESSMENT

TOTAL DUE

COURT ADDRESS

$

$

$

$

$

TIME OF OFFENSE AM

PM



VIOLATOR

MV

OFFENSE

(S)

recyclable

1




16+ PASSENGERS

YES NO

PLACARDED HAZMAT

YES NO

OPERATOR OWNER

PASSENGER BICYCLIST

MAKE AND TYPE COLOR


Sample

OFFIC

ER

’S N

OT

ES

FOR

TE

ST

IFYIN

GIN

CO

UR

T

Please note

factsand

circumstances

in additionto

tho

sech

ecke

do

nthe face

of the citation, that is:

(1) any specificaction of

violator w

hich

increased the hazard of the violation;(2)

where

violation observedand w

here contactm

ade;(3)

totaldistance

traveled during pursuit;

(4) statem

ents by violator and general

attitu

de

.

WE

AT

HE

R

NO

.LAN

ES

:

CLE

AR

CLO

UD

Y

RA

IN

SN

OW

FO

G

SLE

ET

HIG

HW

AY

DR

Y

WE

T

MU

DD

Y

SN

OW

Y

ICY

DIV

IDE

D

TR

AF

FIC

LIGH

T

ME

DIU

M

HE

AV

Y

LIGH

T

DA

YLIG

HT

DA

RK

NE

SS

DA

WN

DU

SK


Sample

REMOVE THIS EDGE BEFORE MAILING

REMEMBER:

R

Check off either the "Payment" or "Hearing Request/Filing Fee" box on the front of this envelope.When paying the citation or requesting a hearing and paying the court filing fee, write the citation number, your license number and state of issue on your check or money order.DO NOT SEND CASH.Enclose the original citation. Make a copy of the citation for your own records.Do not include letters or other information you want a court magistrate to consider; instead, bring this information to your hearing.Report address changes on the front of this envelope.

••

••

•


Sample


Sample


Sample

PLACE STAMPHERE

The Post Officewill not delivermail without

postage

TO SEAL REMOVE BACK FLAP ONLY, MOISTEN OTHER SIDE OF THIS FLAP, AND FOLD OVER.

CHECK HERE IF NEW ADDRESS

PAYMENT

HEARING REQUEST/FILING FEE

CITATION PROCESSING CENTER

PO BOX 55890BOSTON, MA 02205-5890


Sample

Documents

MASSACHUSETTS UNIFORM CITATION R Sample...address city/town plate type offense date (mm/dd/yy) location of offense (include #, st, hwy, city or town) a. chap/ sec/sub crim civil crim