SCSD - Traffic Citation Template

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Officer Information:
Name:
DOB:
Number:
Rank:
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Vehicle Information:
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License Plate Number:
Drivers License Number:
Make:
Model:
Color:
Year:
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Driver Information
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Name:
DOB:
License Number:
Sex:
Signature:
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Occupied: 1[ ] 2[ ] 3[ ] 4[ ] 5[ ] 6[ ]

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Location Information:
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Street Name:
Block Number:
Please of Road: Side [ ] Middle of Road [ ] Parking Lot [ ]

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Citation Type:
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Speeding [ ]
Street Sign/Light Violation [ ]
Parking Violation [ ]

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Officer Signature: ______________
Violator Signature: ______________