In the _________ Court of __________ County
Cause No. _________ Docket No. ___________
Page No. _____
State of Indiana | ||
SS: | No.___________ | |
County of ______________________________________________ | ||
INFORMATION AND SUMMONS |
The undersigned having probable cause to believe and being duly sworn upon his oath says that:
On the ____________ Day of __________, 20 ____ at ____ M
Name ____________________________________________
Last | First | Middle |
Street __________________________________________________
City ______________________ State _____ Zip Code ______
Race ___ Sex ___ Age ___ D.O.B. ______ HT ____ WT _____
Oper. Lic. #_____________ St. ____ Did Unlawfully
Operate Veh. Color _______ Veh. Yr.___ Veh. Make ______
Veh. Lic. Yr. ____ Veh. Lic. St. ____ Veh. Lic. # ______
Upon, (Location)
______________________________________________________
______________________________________________________
A PUBLIC STREET OR HIGHWAY IN ______________________
COUNTY, INDIANA, AND COMMIT, THE OFFENSE OF:
______________________________________________________
______________________________________________________
CONTRARY TO THE FORM OF THE ( ) STATE STATUTE
( ) LOCAL ORDINANCE IN SUCH CASE MADE AND PROVIDED.
OFFICER'S SIGNATURE _________________________________
I.D. No. ______________ Div. Dist. __________________________
POLICE AGENCY _______________________________________
Subscribed And Sworn to Before Me
(Deputy Clerk) ______________________________________
This ____________ Day of _________________, 20 ____
COURT APPEARANCE
COURT APPEARANCE
I PROMISE TO APPEAR IN COURTROOM
__________________________________________________
ADDRESS: ______________________________
ON ______________ THE ________ DAY OF_________, 20 ___ AT __ M. OR BE SUBJECT TO ARREST.
SIGNATURE __________________________________________
"YOUR SIGNATURE IS NOT AN ADMISSION OF GUILT"
The information and summons shall consist of four (4) parts:
The reverse sides of the information and abstract of court record shall be substantially as follows, with such additions or deletions as are necessary to adapt the form to the court involved:
RECEIPT #_______________
DATE ___________________
COURT ACTION AND OTHER ORDERS
BAIL $ ___________
REARREST BOND $ _____________ DATE ___________
1. CONTINUANCE TO ___ | 4. CONTINUANCE TO ____ |
2. CONTINUANCE TO ___ | 5. CONTINUANCE TO ____ |
3. CONTINUANCE TO ___ | 6. CONTINUANCE TO ____ |
Motions | Date | Ruling | Date | |
1. | ___ | ___ | ___ | ___ |
2. | ___ | ___ | ___ | ___ |
3. | ___ | ___ | ___ | ___ |
4. | ___ | ___ | ___ | ___ |
PLEA | ( ) GUILTY |
( ) NOT GUILTY | |
FINDING | ( ) GUILTY |
( ) NOT GUILTY |
THE COURT THEREFORE, ENTERS
THE FOLLOWING ORDER
FINE $ _________ | AMOUNT SUSP. $ ________ |
(STATE) $ _____________ | |
COSTS | |
(CITY) $ ______________ |
___________ DAYS IN _____________ DAYS SUSP. _________
( ) RECOMMENDED LICENSE SUSPENDED FOR _______
( ) PROBATIONARY LICENSE AUTHORIZED FOR ONE YEAR PROBATION
__________________________________________________ |
__________________________________________________ |
__________________________________________________ |
__________________________________________________ |
JUDGE: ______________________________________________
DATE: ______________________________________________
ATTORNEY FOR DEFENDANT _________________
ADDRESS________________________ TELEPHONE _________
WITNESSES |
_________________________________________________ |
_________________________________________________ |
The notice, the appearance, the plea of either guilty or not guilty, and the waiver shall be printed on the summons. The trimmed size of the paper and stock on which the form is printed shall be nominally four and one quarter (4 1/4) inches by eight and one quarter (8 1/4) inches.
In the ____________________ Court of _______________ County
Cause No. ______________ Docket No. ________________
Page No.__________________________
State of Indiana
SS: | No._____________ |
County of ______________________________________
COMPLAINT AND SUMMONS
The undersigned having probable cause to believe and being duly sworn upon his oath says that:
On the ____________ Day of___________, 20 ____ at __ M
Name _________________________________________________
Last | First | Middle |
Street _____________________________________
City ________________________ State _____ Zip Code ________
Race ___ Sex ___ Age __ D.O.B. ________ HT ____ WT ___
Oper. Lic. # ____________ St. ______________ Did Unlawfully
Operate Veh. Color _______ Veh. Yr. ___ Veh. Make _________
Veh. Lic. Yr. ____ Veh. Lic. St. ____ Veh. Lic. # _________
Upon, (Location) _________________________________________
_______________________________________________________
A PUBLIC STREET OR HIGHWAY IN ______________________
COUNTY, INDIANA, AND COMMIT, THE OFFENSE OF:
__________________________________________________ |
__________________________________________________ |
__________________________________________________ |
CONTRARY TO THE FORM OF THE ( ) STATE STATUTE
( ) LOCAL ORDINANCE IN SUCH CASE MADE AND PROVIDED.
OFFICER'S SIGNATURE ___________________________
I.D. No. _____________ Div. Dist. _______________________
POLICE AGENCY _________________________________
Subscribed And Sworn to Before Me
(Deputy Clerk) __________________________________________
This ____________ Day of ______________, 20___
COURT APPEARANCE
I PROMISE TO APPEAR IN ________________________
COURTROOM ___________________________________
ADDRESS: ______________________________________
ON ____________ THE ________ DAY OF ____, 20 ___
AT __ M. OR BE SUBJECT TO ARREST.
SIGNATURE _____________________________________
"YOUR SIGNATURE IS NOT AN ADMISSION OF A VIOLATION"
The complaint and summons shall consist of four (4) parts:
The reverse sides of the complaint and abstract of court record shall be substantially as follows, with such additions or deletions as are necessary to adapt the form to the court involved:
RECEIPT #_________
DATE ________________
COURT ACTION AND OTHER ORDERS
BAIL $ _______________
REARREST BOND $ _________ DATE _______
1. CONTINUANCE TO ______ | 4. CONTINUANCE TO ______ |
2. CONTINUANCE TO ______ | 5. CONTINUANCE TO ______ |
3. CONTINUANCE TO ______ | 6. CONTINUANCE TO ______ |
Motions | Date | Ruling | Date | |
1. | ___ | ___ | ___ | ___ |
2. | ___ | ___ | ___ | ___ |
3. | ___ | ___ | ___ | ___ |
4. | ___ | ___ | ___ | ___ |
PLEA | ( ) ADMIT |
( ) DENY | |
( ) NOLO CONTENDERE | |
FINDING | ( ) JUDGMENT FOR PLAINTIFF |
( ) JUDGMENT FOR DEFENDANT |
THE COURT THEREFORE, ENTERS
THE FOLLOWING ORDER
FINE $ ________ | AMOUNT SUSP. $ ________ |
(STATE) $ __________ | |
COSTS | |
(CITY) $ ___________ |
( ) RECOMMENDED LICENSE SUSPENDED FOR ________
( ) PROBATIONARY LICENSE AUTHORIZED FOR ONE YEAR PROBATION
______________________________________________ |
______________________________________________ |
______________________________________________ |
______________________________________________ |
_______________________________________________ |
JUDGE: _________________________________________
DATE: __________________________________________
ATTORNEY FOR DEFENDANT ____________________
ADDRESS ___________________ TELEPHONE __________
WITNESSES |
_______________________________________________ |
_______________________________________________ |
The notice, appearance, plea of either admission, denial, or nolo contendere shall be printed on the summons. The trimmed size of the paper and stock on which the form is printed shall be nominally four and one quarter (4 1/4) inches by eight and one quarter (8 1/4) inches.
IC 9-30-3-6
Pre-1991 Recodification Citation: 9-4-7-4.