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I CERTIFY UNDER ORS 153.045 AND 153.990 THAT I HAVE SUFFICIENT GROUNDS TO AND DO BELIEVE THAT THE ABOVE <br />MENTIONED PERSON COMMITTED THE ABOVE OFFENSE(S) AND I HAVE SERVED THE PERSON WITH THIS COMPLAINT <br />• I UAI E ISSUED <br />OFFICER'S SIGNATURE OFFICER ID <br />NAME OF ARRESTING PERSON, IF NOT OFFICER <br />)VURVOLMAPPEAAMMI <br />0 PM. <br />3 <br />PHONE <br />-n <br />[]Interpreter Case No. Page of <br />m M <br />STAT ZIP <br />OREGON UNIFORM CITATION AND COMPLAINT <br />T* <br />OTHER <br />-- <br />' <br />L <br />NDATORY APPEARANCE (S�ACK.�) <br />SON- TRAFFIC <br />m <br />E <br />C <br />-4 <br />? <br />r TH O � <br />-AT ONO E AND PLACE IN THEABOV�EmENTIONEDSTATE AND °COUIV Fes, F* x <br />VIOT <br />V <br />VIOLATION <br />0 N <br />260TIONAL APPEARANCE (SEE BACK.) I <br />, <br />@TRAFFIC <br />0 <br />I <br />_ <br />N) <br />STATE OF OREGON !Mnicipal , - C - " B Juvenile-2727 Centennial Blvd. <br />CITY OF EUGENE 2 Circuit-11 25 fth <br />z <br />W <br />6 SAFETY <br />See (Reverse Side.) <br />COUNTY OF LANE I Central Lane Justice-220 51h, Spfld 8 Other <br />D D QPEFR�ATET FO LLOW ING VEHIC WA <br />VEHICLE LICENSE NO. <br />court, see below <br />-, <br />REG. OWNER ■ PROPERTY DAMAGE q �4 4Z , 14 <br />'THE UNDERSIGNED CERTIFIES AND S&STHAT - <br />MODEL STYLE COLOR <br />r <br />NAME: LAST <br />I FIW,5T <br />PUC NO. <br />tm <br />I CERTIFY UNDER ORS 153.045 AND 153.990 THAT I HAVE SUFFICIENT GROUNDS TO AND DO BELIEVE THAT THE ABOVE <br />MENTIONED PERSON COMMITTED THE ABOVE OFFENSE(S) AND I HAVE SERVED THE PERSON WITH THIS COMPLAINT <br />• I UAI E ISSUED <br />OFFICER'S SIGNATURE OFFICER ID <br />NAME OF ARRESTING PERSON, IF NOT OFFICER <br />)VURVOLMAPPEAAMMI <br />0 PM. <br />3 <br />PHONE <br />-n <br />IT! <br />m M <br />STAT ZIP <br />z <br />SSA OR <br />OTHER <br />EMPLOYMENT/SC OOL <br />z DRIVER LICENSE NO. <br />STATE ®.CDL EMPLOYED TO DRIVE <br />0 NON <br />DATE <br />DATE OF B <br />- CD ■PASSENGER <br />WEI GHT EYES <br />r TH O � <br />-AT ONO E AND PLACE IN THEABOV�EmENTIONEDSTATE AND °COUIV Fes, F* x <br />M OFFENSE DATE MONTH <br />DAY YEAR TIME SAM <br />O N OR ABOUT <br />N OR ABOUT: <br />-GAm Km <br />AT OR NEAR LOC <br />LOCATION. <br />6 SAFETY <br />m CORRIDOR <br />D D QPEFR�ATET FO LLOW ING VEHIC WA <br />VEHICLE LICENSE NO. <br />STATE N DRIVILH NOT A, <br />ACCIDENT: 9 PERSONAL INJURY <br />-, <br />REG. OWNER ■ PROPERTY DAMAGE q �4 4Z , 14 <br />VEH. YR. MAKE <br />MODEL STYLE COLOR <br />r <br />i'6 <br />PUC NO. <br />SPEDESTRIAN X HAZ MAT <br />7 <br />■BICYCLE 0 CDL RELATED <br />DTHERECOI <br />1-VIOLATED <br />(CITE ORS/ <br />VVIO. BASIC RULE ALLEGED SPD ZONEIPSTDSPD ■RADAR <br />NVIO. DES SPD <br />ORD. E <br />) <br />@LIDA R <br />■ PACE <br />"H E <br />- n <br />PRES. FfNFISEC. <br />ED <br />m ' (CITE ORS/ <br />Q _ <br />CHARGE <br />z ORI <br />co <br />m <br />PRES. FINE/SEC. Rffly <br />5i <br />av, <br />& VIOLATED <br />CHARGE - <br />(CITE ORS/ <br />01 <br />PRES. FINEISEC.. <br />I CERTIFY UNDER ORS 153.045 AND 153.990 THAT I HAVE SUFFICIENT GROUNDS TO AND DO BELIEVE THAT THE ABOVE <br />MENTIONED PERSON COMMITTED THE ABOVE OFFENSE(S) AND I HAVE SERVED THE PERSON WITH THIS COMPLAINT <br />• I UAI E ISSUED <br />OFFICER'S SIGNATURE OFFICER ID <br />NAME OF ARRESTING PERSON, IF NOT OFFICER <br />)VURVOLMAPPEAAMMI <br />0 PM. <br />3 <br />