ARIZONA TRAFFIC TICKET AND COMPLAINT
Law Enforcement Agency Issuing Ticket

 Report Number

  Please fill the following highlighted fields according to the ticket you received

 Complaint

 Social Security Number

 Military

 Accident Yes No

 Fatality or serious injury Yes No

 Driver's License Number

 State

 Class

M

H

N

P

T

X

D

 DEFENDANT

 First Name
 

 Middle Initial
 

 Last Name
 

Phone
  - -

 Residential Address

 City

 State/Zip Code

 Best Time to Call to

 Sex

 Weight

 Height

 Eyes

 Hair

 Origin

 Date of Birth / / MM/DD/YY

 Restrictions

 Business Address

 City

 State/Country

 Zip Code

 VEHICLE

 Color

 Year

 Make

 Style

 License Plate

 State/Country

 Expir. Date

 Registered Owner ([ ] Same as Defendant)

 Address

 Vehicle Identification Number

THE UNDERSIGNED CERTIFIES THAT:

 ON

 Date(MO/DAY/YR) / / MM/DD/YY

 Time of Day

Speed

 Approx

 Posted

 R&P

 Speed Measurement Device

 Direction of Travel

 AT

 Location

 Precinct

 County

 State of Arizona

THE DEFENDANT COMMITTED THE FOLLOWING:

A

 Section

ARS

Violation

[  ] Domestic Violence Case 

CC

VIOLATION 1

[  ] Criminal

[  ] Criminal Traffic  

[  ] Civil Traffic

[  ] Petty Offense  

B

 Section

ARS

  

[  ] Domestic Violence Case  

CC

VIOLATION 2

[  ] Criminal

[  ] Criminal Traffic  

[  ] Civil Traffic

[  ] Petty Offense  

C

 Section

ARS

  

[  ] Domestic Violence Case 

CC

VIOLATION 3

[  ] Criminal

[  ] Criminal Traffic  

[  ] Civil Traffic

[  ] Petty Offense  

D

 Section

ARS

  

[  ] Domestic Violence Case 

CC

VIOLATION 4

[  ] Criminal

[  ] Criminal Traffic  

[  ] Civil Traffic

[  ] Petty Offense  

E

 Section

ARS

  

[  ] Domestic Violence Case 

CC

VIOLATION 5

[  ] Criminal

[  ] Criminal Traffic  

[  ] Civil Traffic

[  ] Petty Offense  

 YOU MUST APPEAR AT

 Court Name

 Court Number

 Court Phone - -

 AT THE DATE INDICATED

 Date / / MM/DD/YY

 Time of the Day                 [  ] AM   [  ] PM
          

AZ "Crash Course" in Traffic Safety
955 W. Chandler Blvd. #9, Chandler, AZ 85225
480-857-4740 or 602-277-0102 or 623-486-0037 or 800-515-9599
www.AZCCTS.com

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