CRIMINAL CITATION - PART 1 - FACE

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2 RIMINAL ITATION - PART 1 - FAE RIMINAL DRIVER S LIENSE. STATE EXPIRES PHOTO I.D. MATHED TRAFFI N-TRAFFI IN THE DISTRIT MUNIIPAL OURT OF OUNTY OF ITY/TOWN OF L.E.A. ORI #: OURT ORI #: THE UNDERSIGNED ERTIFIES AND SAYS THAT IN THE STATE OF WASHINGTON DL IF NEW ITY STATE ZIP ODE EMPLOYER LOATION OF BIRTH RAE SEX HEIGHT WEIGHT E HAIR RESIDENTIAL PHONE. ELL/PAGER. WORK PHONE. VIOLATION MONTH DAY YEAR TIME INTERPRETER NEEDED AT LOATION M.P. ITY/OUNTY OF DID OPERATE THE FOLLOWING VEHILE/MOTOR VEHILE ON A PUBLI HIGHWAY AND VEHILE LIENSE. STATE EXPIRES VEH. YR. MAKE MODEL STYLE OLOR TRAILER #1 LIENSE. STATE EXPIRES TR. YR. TRAILER #2 LIENSE. STATE EXPIRES TR. YR. OWNER/OMPANY IF OTHER THAN DRIVER ITY STATE ZIP ODE AIDENT BA MV 16 + NR R I F READING PASS VEHILE R.V. OTHER #1 VIOLATION/STATUTE ODE DID THEN AND THERE OMMIT EAH OF THE FOLLOWING OFFENSES #2 VIOLATION/STATUTE ODE MANDATORY OURT APPEARANE APPEARANE RELATED # ISSUED ABSTRAT OF JUDGMENT Sent to ourt for Mailing I ERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT I HAVE ISSUED THIS ON THE AND AT THE LOATION ABOVE, THAT I HAVE PROBABLE AUSE TO BELIEVE THE ABOVE NAMED PERSON OMMITTED THE ABOVE OFFENSE(S). OMPLAINT / ITATION RG PLEA NG FINDINGS FINE SUSPENDED SUB-TOTAL 1 G NG G NG D $ $ $ 2 G NG G NG D $ $ $ REOMMENDED NEXTENSION OF SUSPENSION LIENSE SUR- RENDER OTHER OSTS $ TOTAL OSTS $ FIND/JUDG ABS. MLD TO OLY TO SERVE WITH REDIT / TIME SVD DAYS SUP. WASHINGTON UNIFORM OURT DOKET - OURT OPY WASHINGTON UNIFORM OURT DOKET - DOL OPY WASHINGTON UNIFORM OURT DOKET - DEFENDANT OPY WASHINGTON UNIFORM OURT DOKET - LEA OPY WASHINGTON UNIFORM OFFIERS REPORT - OPY

3 RIMINAL ITATION - PART 2 - FAE RIMINAL DRIVER S LIENSE. STATE EXPIRES PHOTO I.D. MATHED TRAFFI N-TRAFFI IN THE DISTRIT MUNIIPAL OURT OF OUNTY OF ITY/TOWN OF L.E.A. ORI #: OURT ORI #: THE UNDERSIGNED ERTIFIES AND SAYS THAT IN THE STATE OF WASHINGTON DL IF NEW ITY STATE ZIP ODE EMPLOYER LOATION OF BIRTH RAE SEX HEIGHT WEIGHT E HAIR RESIDENTIAL PHONE. ELL/PAGER. WORK PHONE. VIOLATION MONTH DAY YEAR TIME INTERPRETER NEEDED AT LOATION M.P. ITY/OUNTY OF DID OPERATE THE FOLLOWING VEHILE/MOTOR VEHILE ON A PUBLI HIGHWAY AND VEHILE LIENSE. STATE EXPIRES VEH. YR. MAKE MODEL STYLE OLOR TRAILER #1 LIENSE. STATE EXPIRES TR. YR. TRAILER #2 LIENSE. STATE EXPIRES TR. YR. OWNER/OMPANY IF OTHER THAN DRIVER ITY STATE ZIP ODE AIDENT BA MV 16 + NR R I F READING PASS VEHILE R.V. OTHER #1 VIOLATION/STATUTE ODE DID THEN AND THERE OMMIT EAH OF THE FOLLOWING OFFENSES #2 VIOLATION/STATUTE ODE MANDATORY OURT APPEARANE APPEARANE RELATED # ISSUED ABSTRAT OF JUDGMENT Sent to ourt for Mailing OMPLAINT / ITATION RG PLEA NG FINDINGS FINE SUSPENDED SUB-TOTAL 1 G NG G NG D $ $ $ 2 G NG G NG D $ $ $ REOMMENDED NEXTENSION OF SUSPENSION I ERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT I HAVE ISSUED THIS ON THE AND AT THE LOATION ABOVE, THAT I HAVE PROBABLE AUSE TO BELIEVE THE ABOVE NAMED PERSON OMMITTED THE ABOVE OFFENSE(S). LIENSE SUR- RENDER OTHER OSTS $ TOTAL OSTS $ FIND/JUDG ABS. MLD TO OLY TO SERVE WITH REDIT / TIME SVD DAYS SUP. WASHINGTON UNIFORM OURT DOKET - OURT OPY WASHINGTON UNIFORM OURT DOKET - DOL OPY WASHINGTON UNIFORM OURT DOKET - DEFENDANT OPY WASHINGTON UNIFORM OURT DOKET - LEA OPY WASHINGTON UNIFORM OFFIERS REPORT - OPY

4 RIMINAL ITATION - PART 3 - FAE RIMINAL IN THE DISTRIT MUNIIPAL OURT OF OUNTY OF ITY/TOWN OF DRIVER S LIENSE. STATE EXPIRES PHOTO I.D. MATHED TRAFFI N-TRAFFI L.E.A. ORI #: OURT ORI #: THE UNDERSIGNED ERTIFIES AND SAYS THAT IN THE STATE OF WASHINGTON DL IF NEW ITY STATE ZIP ODE EMPLOYER LOATION OF BIRTH RAE SEX HEIGHT WEIGHT E HAIR RESIDENTIAL PHONE. ELL/PAGER. WORK PHONE. VIOLATION MONTH DAY YEAR TIME INTERPRETER NEEDED AT LOATION M.P. ITY/OUNTY OF DID OPERATE THE FOLLOWING VEHILE/MOTOR VEHILE ON A PUBLI HIGHWAY AND VEHILE LIENSE. STATE EXPIRES VEH. YR. MAKE MODEL STYLE OLOR TRAILER #1 LIENSE. STATE EXPIRES TR. YR. TRAILER #2 LIENSE. STATE EXPIRES TR. YR. OWNER/OMPANY IF OTHER THAN DRIVER ITY STATE ZIP ODE AIDENT BA MV 16 + NR R I F READING PASS VEHILE R.V. OTHER #1 VIOLATION/STATUTE ODE DID THEN AND THERE OMMIT EAH OF THE FOLLOWING OFFENSES READ THE BAK #2 VIOLATION/STATUTE ODE MANDATORY OURT APPEARANE APPEARANE RELATED # ISSUED Sent to ourt for Mailing I ERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT I HAVE ISSUED THIS ON THE AND AT THE LOATION ABOVE, THAT I HAVE PROBABLE AUSE TO BELIEVE THE ABOVE NAMED PERSON OMMITTED THE ABOVE OFFENSE(S). YOU MUST RESPOND TO THE OURT BELOW AORDING TO THE INSTRUTIONS ON THE REVERSE SIDE OF THIS TIE WASHINGTON UNIFORM OURT DOKET - OURT OPY WASHINGTON UNIFORM OURT DOKET - DOL OPY WASHINGTON UNIFORM OURT DOKET - DEFENDANT OPY WASHINGTON UNIFORM OURT DOKET - LEA OPY WASHINGTON UNIFORM OFFIERS REPORT - OPY

5 RIMINAL ITATION - PART 4 - FAE RIMINAL IN THE DISTRIT MUNIIPAL OURT OF OUNTY OF ITY/TOWN OF L.E.A. ORI #: OURT ORI #: DRIVER S LIENSE. STATE EXPIRES PHOTO I.D. MATHED TRAFFI N-TRAFFI THE UNDERSIGNED ERTIFIES AND SAYS THAT IN THE STATE OF WASHINGTON DL IF NEW ITY STATE ZIP ODE EMPLOYER LOATION OF BIRTH RAE SEX HEIGHT WEIGHT E HAIR RESIDENTIAL PHONE. ELL/PAGER. WORK PHONE. VIOLATION MONTH DAY YEAR TIME INTERPRETER NEEDED AT LOATION M.P. ITY/OUNTY OF DID OPERATE THE FOLLOWING VEHILE/MOTOR VEHILE ON A PUBLI HIGHWAY AND VEHILE LIENSE. STATE EXPIRES VEH. YR. MAKE MODEL STYLE OLOR TRAILER #1 LIENSE. STATE EXPIRES TR. YR. TRAILER #2 LIENSE. STATE EXPIRES TR. YR. OWNER/OMPANY IF OTHER THAN DRIVER ITY STATE ZIP ODE AIDENT BA MV 16 + NR R I F READING PASS VEHILE R.V. OTHER #1 VIOLATION/STATUTE ODE DID THEN AND THERE OMMIT EAH OF THE FOLLOWING OFFENSES #2 VIOLATION/STATUTE ODE MANDATORY OURT APPEARANE APPEARANE RELATED # ISSUED Sent to ourt for Mailing I ERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT I HAVE ISSUED THIS ON THE AND AT THE LOATION ABOVE, THAT I HAVE PROBABLE AUSE TO BELIEVE THE ABOVE NAMED PERSON OMMITTED THE ABOVE OFFENSE(S). DO T WRITE IN THIS SETION WASHINGTON UNIFORM OURT DOKET - OURT OPY WASHINGTON UNIFORM OURT DOKET - DOL OPY WASHINGTON UNIFORM OURT DOKET - DEFENDANT OPY WASHINGTON UNIFORM OURT DOKET - LEA OPY WASHINGTON UNIFORM OFFIERS REPORT - OPY

6 RIMINAL ITATION - PART 5 - FAE RIMINAL IN THE DISTRIT MUNIIPAL OURT OF OUNTY OF ITY/TOWN OF L.E.A. ORI #: OURT ORI #: DRIVER S LIENSE. STATE EXPIRES PHOTO I.D. MATHED TRAFFI N-TRAFFI THE UNDERSIGNED ERTIFIES AND SAYS THAT IN THE STATE OF WASHINGTON DL IF NEW ITY STATE ZIP ODE EMPLOYER LOATION OF BIRTH RAE SEX HEIGHT WEIGHT E HAIR RESIDENTIAL PHONE. ELL/PAGER. WORK PHONE. VIOLATION MONTH DAY YEAR TIME INTERPRETER NEEDED AT LOATION M.P. ITY/OUNTY OF DID OPERATE THE FOLLOWING VEHILE/MOTOR VEHILE ON A PUBLI HIGHWAY AND VEHILE LIENSE. STATE EXPIRES VEH. YR. MAKE MODEL STYLE OLOR TRAILER #1 LIENSE. STATE EXPIRES TR. YR. TRAILER #2 LIENSE. STATE EXPIRES TR. YR. OWNER/OMPANY IF OTHER THAN DRIVER ITY STATE ZIP ODE AIDENT BA MV 16 + NR R I F READING PASS VEHILE R.V. OTHER #1 VIOLATION/STATUTE ODE DID THEN AND THERE OMMIT EAH OF THE FOLLOWING OFFENSES #2 VIOLATION/STATUTE ODE MANDATORY OURT APPEARANE APPEARANE RELATED # ISSUED Sent to ourt for Mailing OFFIER REMARKS I ERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT I HAVE ISSUED THIS ON THE AND AT THE LOATION ABOVE, THAT I HAVE PROBABLE AUSE TO BELIEVE THE ABOVE NAMED PERSON OMMITTED THE ABOVE OFFENSE(S). WASHINGTON UNIFORM OURT DOKET - OURT OPY WASHINGTON UNIFORM OURT DOKET - DOL OPY WASHINGTON UNIFORM OURT DOKET - DEFENDANT OPY WASHINGTON UNIFORM OURT DOKET - LEA OPY WASHINGTON UNIFORM OFFIERS REPORT - OPY

7 RIMINAL ITATION - PART 1 - BAK OFFIER REPORT TRAFFI WEATHER STREET LIGHT LT MED HV L RN FG SN D W I S D DWN DSK DK Officer s Report for itation # The information contained on this citation is incorporated by reference into this report. I ERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND AURATE Signature # Date and Place WITNESS NAME (LAST, FIRST, M.I.) PHONE ITY STATE ZIP WITNESS NAME (LAST, FIRST, M.I.) PHONE ITY STATE ZIP INIDENT NUMBER RELATED ITATION/INFRATION NUMBERS APPROVING OFFIER/.

8 RIMINAL ITATION - PART 3 - BAK RIMINAL ITATION You are charged with the crime(s) described on the other side of this form. MANDATORY APPEARANE One of the following options applies: 1. If there is a date in the appearance date box you must appear in court at that date and time. 2. If there is a number in the appearance date box you must appear in court within the number of days indicated. 3. If the appearance date box is blank, the court will notify you in writing when to appear. If you do not receive a notice within fifteen (15) days please contact the court immediately. When you appear, you will be advised of your constitutional rights and the possible penalties if you are convicted. You also may be asked to enter a plea of T GUILTY or GUILTY. IF YOU DO T APPEAR THIS MAY RESULT IN A WARRANT FOR YOUR ARREST AND DETENTION IN JAIL. ALSO, IF TRAFFI IS HEKED ON THE FRONT YOU WILL LOSE YOUR DRIVER S LIENSE/PRIVILEGE. IF RW LISTED ON FRONT APPEARS BELOW PLEASE READ RW Driving Under the Influence (DUI) - drive a motor vehicle and either: have a 0.08 breath or blood alcohol content within 2 hours after driving, or be under the influence of or affected by liquor, any drug, or a combination of liquor and any drug. RW (1)(a) First Degree Driving While Suspended/Revoked (DWLS) - be an habitual traffic offender and drive a motor vehicle while an order of revocation issued under chapter RW prohibiting such operation is in effect. RW (1)(b) Second Degree Driving While Suspended/Revoked (DWLS) - drive a motor vehicle while an order of suspension or revocation prohibiting such operation is in effect, and not be eligible to reinstate the license or driving privilege. RW ( 1) (c) Third Degree Driving While Suspended/Revoked (DWLS) - drive a motor vehicle while the license or privilege to drive is suspended or revoked for (1) failure to furnish proof of satisfactory progress in a required alcoholism or drug treatment program; or (2) failure to furnish proof of financial responsibility pursuant to chapter RW; or (3) failure to comply with chapter RW relating to uninsured accidents; or (4) failure to respond to a notice of traffic infraction, failure to appear at a requested hearing, violation of a written promise to appear in court, or failure to comply with the terms of a notice of traffic infraction or citation; or (5) suspension or revocation in another state that would not result in suspension or revocation in this state; or (6) failure to reinstate the driver s license or privilege after suspension or revocation in the second degree; or (7) the person has a suspension under RW relating to intermediate drivers' licenses, or any combination of the above. Traffic citations may go on your driving record. PLEASE TIFY THE OURT IMMEDIATELY IF YOUR MAILING HAS HANGED OR IS IRRET.