20_362564_proof_01.pdf
PDF 849 KB Posted
- Attached to
- DNR PR 3330 APPERANCE TICKET BOOKS
- Solicitation number
- RFQ 171 250000000341 1
- Issued by
- Grand Traverse County, Michigan
About this file
This document is a Civil Infraction Complaint form from the State of Michigan Department of Natural Resources. The multi-part form serves as the official citation and complaint document used by conservation officers to document violations of state law, local ordinances, administrative rules, commission orders, directors orders, or tribal regulations related to natural resources enforcement.
The form captures comprehensive incident information including the date, time, location, and day of week of the alleged violation, along with detailed defendant information such as name, address, driver's license number, physical description, and vehicle details. The document provides sections for officers to document the specific violation type, any warnings issued, seized property, vehicle impoundment, injuries, and whether formal hearings are required. The multi-part form includes separate copies for court proceedings, prosecution, and defendant notification. Subsequent sections document the verdict or determination, including disposition options ranging from guilty to not guilty to dismissed, along with associated fines, costs, state fees, restitution, and judgment fees. The form also includes provisions for license revocation related to hunting and fishing privileges, with checkboxes for various license types. Additional pages address the disposition of seized property, with signature lines for both the defendant and district supervisor authorization. The form was last updated on February 15, 2023, and is designed as a standardized instrument for Michigan Department of Natural Resources enforcement actions.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| DNR PR 3330 Appearance Ticket Books 4-25 BID REQUEST.docx | DOCX document | |
| 20_362562_proof_01_FontsEmbedded Revised.pdf | ||
| standard-contract-terms-short-form (7) (7) (1).docx | DOCX document | |
| State of Michigan Print Mail Management Terms Conditions (1).docx | DOCX document | |
| 20_362558_proof_01.pdf |
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Text version
½ in False Stub
362564 PT1 FACE INK: BLACK
State of Michigan Department of Natural Resources
Date of Issue
The Undersigned, Being Duly Sworn States That on, or Has Reasonable Cause To Believe That On or About Agency Use
Month Day Year At Approx AM
PM
Day of Week
YES NO
Name (First, Middle, Last)
Street
City State ZIP
State Driver’s License Number
Race Sex Date of Birth Height Weight Hair Eyes Scars or Marks
Type Vehicle Plate No. Year State Vehicle Description (Make, Model, Color)
Employed
The Person Named Above did in Violation of 1. State Law 2. Local Ordinance
3. Administrative Rule 4. Commission Order 5. Directors Order 6. Tribal
At or Near
Within City Village Township of
County of Did the Following
C/I Warn Conservation Fee
Misd Fug Fel
YES NO
A
C/I Warn Conservation Fee Misd Fug Fel
YES NO
B
Seized Property YES NO If yes, Describe
Damage to Property Local Court Bond $ Vehicle Impounded Injury License Posted in Lieu of Bond
Traffic Crash Death Appearance Certificate
Person in Active Military Service YES NO None
Appearance Date on or Before
Hearing Date (if Applicable ) on Contact Court Juvenile Traffic Misd. (Court Will Notify) Formal Hearing Required (Court Will Notify)
In the Court of
Court Address & Telephone
I Served a Copy of the Civil Infraction Complaint Upon the Defendant.
Officer’s Name (Please Print) Officer’s ID No.
I declare under the penalties of perjury that the statements above are true to the best of my information, knowledge, and belief.
Complainant’s Signature and Receipt if Applicable Date
Agency’s ORI Agency Name
Court Copy
PR
PR
000001
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000001
½ in False Stub
362564 PT2 FACE INK: BLACK
Has Reasonable Cause To Believe That On or About Agency Use
Month Day Year At Approx AM
PM
Day of Week
YES NO
Name (First, Middle, Last)
Street
City State ZIP
State Driver’s License Number
Race Sex Date of Birth Height Weight Hair Eyes Scars or Marks
Type Vehicle Plate No. Year State Vehicle Description (Make, Model, Color)
Employed
The Person Named Above did in Violation of 1. State Law 2. Local Ordinance
3. Administrative Rule 4. Commission Order 5. Directors Order 6. Tribal
At or Near
Fel
YES NO
A
C/I Warn Conservation Fee Misd Fug Fel
YES NO
B
Seized Property YES NO If yes, Describe
Damage to Property Local Court Bond $ Vehicle Impounded Injury License Posted in Lieu of Bond
Traffic Crash Death Appearance Certificate
Person in Active Military Service YES NO None
Appearance Date on or Before
Hearing Date (if Applicable ) on Contact Court Juvenile Traffic Misd. (Court Will Notify) Formal Hearing Required (Court Will Notify)
In the Court of
Court Copy
PR
PR
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Has Reasonable Cause To Believe That On or About Agency Use
Month Day Year At Approx AM
PM
Day of Week
YES NO
Name (First, Middle, Last)
Street
City State ZIP
State Driver’s License Number
Race Sex Date of Birth Height Weight Hair Eyes Scars or Marks
Type Vehicle Plate No. Year State Vehicle Description (Make, Model, Color)
Employed
The Person Named Above did in Violation of 1. State Law 2. Local Ordinance
3. Administrative Rule 4. Commission Order 5. Directors Order 6. Tribal
At or Near
Fel
YES NO
A
C/I Warn Conservation Fee Misd Fug Fel
YES NO
B
Seized Property YES NO If yes, Describe
Damage to Property Local Court Bond $ Vehicle Impounded Injury License Posted in Lieu of Bond
Traffic Crash Death Appearance Certificate
Person in Active Military Service YES NO None
Appearance Date on or Before
Hearing Date (if Applicable ) on Contact Court Juvenile Traffic Misd. (Court Will Notify) Formal Hearing Required (Court Will Notify)
In the Court of
PR
PR
000001
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Verdict / Determination Date Amended Charge
1 Guilty 2 Guilty as Amended 3 Not Guilty 4 Nolle Prosequi
5 Dismissed 6 Responsible 7 By Default 8 Not Responsible
9 Deferred 10 Delayed
Fines
Costs
State Fees
Reimbursement
Judgment fee
Additional Sanctions (Restitution) To be Paid by
License Revocation
I understand that i am ineligible to secure the licenses checked below until after the date of
(AL) All Licenses (D) Deer
(AHAF) All Hunt and Fish (B) Bear
(AHAT) All Hunt and Trap (AT) All Trap
(AH) All Hunting (AF) All Fish
(DB) Deer and Bear Other
Defendant’s Signature
Judge / Magistrate / Clerk
Verdict / Determination Date Amended Charge
1 Guilty 2 Guilty as Amended 3 Not Guilty 4 Nolle Prosequi
5 Dismissed 6 Responsible 7 By Default 8 Not Responsible
9 Deferred 10 Delayed
Fines
Costs
State Fees
Reimbursment
Judgement fee
Additional Sanctions (Restitution) To be Paid by
License Revocation
I understand that i am ineligible to secure the licenses checked below until after the date of
(AL) All Licenses (D) Deer
(AHAF) All Hunt and Fish (B) Bear
(AHAT) All Hunt and Trap (AT) All Trap
(AH) All Hunting (AF) All Fish
(DB) Deer and Bear Other
Defendant’s Signature
Judge / Magistrate / Clerk
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Has Reasonable Cause To Believe That On or About Agency Use
Month Day Year At Approx AM
PM
Day of Week
YES NO
Name (First, Middle, Last)
Street
City State ZIP
State Driver’s License Number
Race Sex Date of Birth Height Weight Hair Eyes Scars or Marks
Type Vehicle Plate No. Year State Vehicle Description (Make, Model, Color)
Employed
The Person Named Above did in Violation of 1. State Law 2. Local Ordinance
3. Administrative Rule 4. Commission Order 5. Directors Order 6. Tribal
At or Near
Fel
YES NO
A
C/I Warn Conservation Fee Misd Fug Fel
YES NO
B
Seized Property YES NO If yes, Describe
Damage to Property Local Court Bond $ Vehicle Impounded Injury License Posted in Lieu of Bond
Traffic Crash Death Appearance Certificate
Person in Active Military Service YES NO None
Appearance Date on or Before
Hearing Date (if Applicable ) on Contact Court Juvenile Traffic Misd. (Court Will Notify) Formal Hearing Required (Court Will Notify)
In the Court of y
Officer – Prosecutor Copy
Agenc ’s ORI Agency Name
PR
PR
000001
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Indicate disposition of all seized property. Obtain signed receipts as needed.
The property listed on the front of this ticket was returned to me in the same condition as when it was seized.
Defendants Signature Date
The property listed on the front of this ticket has been properly disposed of, or turned over to my control.
District Supervisor Authorized Signature Date
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Has Reasonable Cause To Believe That On or About Agency Use
Month Day Year At Approx AM
PM
Day of Week
YES NO
Name (First, Middle, Last)
Street
City State ZIP
State Driver’s License Number
Race Sex Date of Birth Height Weight Hair Eyes Scars or Marks
Type Vehicle Plate No. Year State Vehicle Description (Make, Model, Color)
Employed
The Person Named Above did in Violation of 1. State Law 2. Local Ordinance
3. Administrative Rule 4. Commission Order 5. Directors Order 6. Tribal
At or Near
Fel
YES NO
A
C/I Warn Conservation Fee Misd Fug Fel
YES NO
B
Seized Property YES NO If yes, Describe
Damage to Property Local Court Bond $ Vehicle Impounded Injury License Posted in Lieu of Bond
Traffic Crash Death Appearance Certificate
Person in Active Military Service YES NO None
Appearance Date on or Before
Hearing Date (if Applicable ) on Contact Court Juvenile Traffic Misd. (Court Will Notify) Formal Hearing Required (Court Will Notify)
In the Court of
Misdemeanor - Defendant
Agency’s ORI Agency Name
PR
PR
000001
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Has Reasonable Cause To Believe That On or About Agency Use
Month Day Year At Approx AM
PM
Day of Week
YES NO
Name (First, Middle, Last)
Street
City State ZIP
State Driver’s License Number
Race Sex Date of Birth Height Weight Hair Eyes Scars or Marks
Type Vehicle Plate No. Year State Vehicle Description (Make, Model, Color)
Employed
The Person Named Above did in Violation of 1. State Law 2. Local Ordinance
3. Administrative Rule 4. Commission Order 5. Directors Order 6. Tribal
At or Near
Fel
YES NO
A
C/I Warn Conservation Fee Misd Fug Fel
YES NO
B
Seized Property YES NO If yes, Describe
Damage to Property Local Court Bond $ Vehicle Impounded Injury License Posted in Lieu of Bond
Traffic Crash Death Appearance Certificate
Person in Active Military Service YES NO None
Appearance Date on or Before
Hearing Date (if Applicable ) on Contact Court Juvenile Traffic Misd. (Court Will Notify) Formal Hearing Required (Court Will Notify)
In the Court of
Civil Infraction
Agency’s ORI Agency Name
PR
PR
000001
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