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