Ill. Admin. Code tit. 92, § A - Illinois Citation and Complaint

C/C No. 1753

#1 COMPLAINT

VEHICLE INSPECTION COPY

Hearing Docket No. ______________________

State of Illinois

County of _________________________________________________________________

City or Township of __________________________________________________________

People of the State of Illinois, Plaintiff v.

Name _____________________________________________________________________

Defendant Certified Mechanic Owner/Operator

Lane Name _________________________________________________________________

Address ____________________________________________________________________

City & State __________________________________________________________________

Veh. Test. Station No. ___________________________________________________________

Certified Mechanic Permit No. ______________________________________________________

The undersigned says that on ___________________/________________/____________________

Month Day Year

at ___________________ a.m./p.m. defendant did unlawfully:

Violate Section _______ of the Illinois Vehicle Code

in that he: _____________________________________________

Violate Section ___________________of the Illinois Rules & Regulations Inspection_________

Manual in that he: ______________________________________________________

______________________________________________________________________

______________________________________________________________________

_______________Dated________________ /________________/__________________

Month Day Year

Inspector's Signature I.D. Number

If you choose to appear to answer to the above charges, report to:

______________________________________________________________________

on ________________ /________________/__________________ at _______ a.m./p.m.

Month Day Year

In the event I fail to appear, I hereby consent to the entry of an exparte judgment against me and assessment of whatever fines or determination may be assessed against me.

Signature______________________

Title _________________

Notes

Ill. Admin. Code tit. 92, § A