There is established a uniform complaint and summons that may be used in cases involving
violations of statutes or ordinances. The use of a uniform complaint and summons must comply
with the North Dakota Rules of Criminal Procedure and be in substantially the following form:
State of North Dakota ) In ___________________ Court,
) ss.
County of ____________ ) Before Hon. ________________;
The undersigned, being sworn, says that, on ______________, ______,
___________________________________________________________________
First Name Middle Name Last Name Street City State
did unlawfully operate a motor vehicle upon a public highway, namely
__________, _______ N E S W of __________ and did then and there commit
Location City
the following offense:_____________________________________________
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There is established a uniform complaint and summons that may be used in cases involving
violations of statutes or ordinances. The use of a uniform complaint and summons must comply
with the North Dakota Rules of Criminal Procedure and be in substantially the following form:
State of North Dakota ) In ___________________ Court,
) ss.
County of ____________ ) Before Hon. ________________;
The undersigned, being sworn, says that, on ______________, ______,
___________________________________________________________________
First Name Middle Name Last Name Street City State
did unlawfully operate a motor vehicle upon a public highway, namely
__________, _______ N E S W of __________ and did then and there commit
Location City
the following offense:_____________________________________________________
MPH in________________________________________________________________
MPH Zone_____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
All in violation of N. D. Century Code Sec. ______ and against the peace and dignity
of the state of N. D.
Officer _________ LET A WARRANT ISSUE HEREIN Sworn to and subscribed
before me on ______________, ______.
____________________________ ___________________________________
Judge State's Attorney
DESCRIPTION OF DEFENDANT AND VEHICLE
Mo. _____Day _____Yr. _____Race _____Sex _____Wt. ______Ht. _____
Birth date
Hair _____Dr. Lic: State _____No. _____Motor Vehicle:
PSC
Make _____Reg. No. _____State _____Year _____ICC No. ____
CLAIMED CONDITIONS OF THE VIOLATION
SLIPPERY SURFACE
______ Rain ______ Snow ______ Ice
DARKNESS
______ Night ______ Fog ______ Snow
OTHER TRAFFIC PRESENT
______ Cross ______ Oncoming ______ Pedestrian ______ Same direction
IN ACCIDENT
______ Ped. ______ Vehicle ______ Intersection
______ Right angle ______ Head on ______ Rear end
______ Ran off road ______ Other
_______________________________________________________________
Area: ______ School ______ Rural ______ Business
______ Industrial ______ Residential
Highway: _______ 2 Lane ______ 4 Lane ______ 4 Lane Divided
Type:
_________ Gravel ________ Dirt
OFFENSE CONTRIBUTED MATERIALLY TO ACCIDENT
_____ Yes ______ No
THE STATE OF NORTH DAKOTA TO THE ABOVE-NAMED DEFENDANT
(CITY ORDINANCE OR STATE CRIMINAL TRAFFIC VIOLATION)
You are summoned to appear at the time and place designated below to answer to the
charge made against you.
______________________________________________________________________
______________________________________________________________________
Appearance
Before: Municipal Judge District Ct.__________________________________
_______________________________________________________________A.M./P.M.
Location Month Day Year Time
Dated ______________, ______
Officer _________________________
PROMISE TO APPEAR
I consent and promise to appear at the time and place specified in the above summons, the
receipt of a copy of which is acknowledged, and I expressly waive earlier hearing.
Dated ______________, ______
Defendant ______________________
(STATE NONCRIMINAL TRAFFIC VIOLATION)
You are notified of your right to request, within fourteen days of the date of this citation, a
hearing concerning the alleged traffic violation. If you do not request a hearing, the bond is
deemed forfeited and the violation admitted. If you are requesting a hearing, date and sign the
following portion of this citation AND INCLUDE THE BOND NOTED ON THIS CITATION for the
alleged violation. Failure to do so may result in the suspension of your operator's license. You
will be notified of the hearing date by the court for the county in which this citation was issued.
REQUEST FOR HEARING
I submit the designated bond and request a hearing on the alleged traffic violation and
promise to appear at the time and date specified in the summons issued by the court for the
county in which the citation was issued.
Dated _______________, ___________
Defendant ________________________