RIGHTS AND OBLIGATIONS

1. The original of this traffic citation/summons will be filed before the MAGISTERIAL DISTRICT JUDGE WHOSE
ADDRESS IS LISTED IN ITEM 3 on the reverse side.
2. Within TEN (10) days of the issuance or receipt of this traffic citation/summons, you must:
a. PLEAD NOT GUILTY by notifying the proper Magisterial District Judge in writing, signing the appropriate plea
below, and by forwarding for collateral an amount equal to the Jotal Due as specified in ITEM 34 on
the reverse side, plus $7.00 if the offense charged is under the Vehicle Code; or, if the Total Due is not
specified, by forwarding the sum of $50.00 as collateral for your appearance at trial.
OR
b. PLEAD NOT GUlL TV by appearing before the proper Magisterial . trict Judge and posting such collateral
for your appearance as the M~t?1 District JUd6~ shall re~.

c. Appear before the proper MagiS~ District Judge to enter atplea if you cannot afford to pay the Total Due
as specified on the traffic citati n/summons, or the $50.00 c0d,~ral.

d. PLEAD GUILTY by appear" efore ~he

er 3~9i:!~istrict Judge if the Total Due is not specified,
or if you are required to a r pursuant.R.Crim.. (8)(3) or 414(8)(3).
R
e. PLEAD GUILTY by ~ g before toper Ma . eria District Judge if the Total Due is not specified.
3. If you are found guilty by Magisterjpl District Judge, ou plead guilty, and you wish to appeal, you have
THIRTY (30) days to file n appeal for <Niial in the Court Common Pleas.
4. All checks or money~ers must b~de payableihe "Magisterial District Number __ ,__ ,__ "
identified in ITEM 1 verse side, ~ sent to the ess reported in ITEM 3.
5. If you have n ch r d with a MJnJmary offen~ er the Vehicle Code, failure to respond within the time
specified a ve will esult i~u~nsion of yo r 'er's license and the issuance of a summons, or a warrant
for your arr t.
6. If you have b arged wit~vi~ ation f a local inance or any parking offense, failure to respond within the
time specified above will result in~e issua e of a summons.
7. If you fall to appear fortrial, the trial may be Id in your absence.
8. If you are disabled and require assistance, pie tact the Magisterial District Office identified in Item 3 on the
reverse side.

INSTRUCTIONS FOR RESPONSE BY MAIL

If you intend to respond by mail:.
1. Detach and complete the lower portion of this traffic citation/summons with your signature on the appropriate
plea line (a. or b.).
2. If you PLEAD NOT GUILTY, your check or money order for collateral must be in the amount reported as Total
Due in ITEM 34, as specified on the reverse side, plus $7.00 costs. If the Total Due is not specified, your check
or money order for collateral must be in the amount of $50.00. You will be notified by mail of your trial date.
3. If you PLEAD GUlL TV, enclose a check or money order in the amount reported as Total Due as specified on
the traffic citation/summons. Failure to remit the full amount reported in ITEM 34 as Total Due may result in the
issuance of a warrant for your arrest.
4. Your check or money order must be made payable to the "Magisterial District Number __ •__ ,__ "
identified in ITEM 1 on reverse side, and sent to the address reported in ITEM 3.

E.M.S. Emergency Medical Services Act.

Explanation of blocks 30,31, & 33 MCARE Medical Care Availability and Reduction of Error Fund.
{
J.C.P.lA.T.J. Judicial Computer ProjecVAccess to Justice.

I L' ( { ; M fL IN PORTION f'

-(he <Ase 0 t VIe 11.~~.<..cA..l., "' f6re(J~ ~ 0+ t"'4Uc> o...d. ~Ct,,~~rf-
~ i~ionJe! ht1!~ci~jon/7!an~/ctY!(;k&~~order6narLe~~~ ~~,I.
Magi~rial . trict, ice w e aOcltes!i ,is' p~rt. d in"E~ ~l~nthe e~.}idf.:JVCIJ .:. •~ Iii
I~ters ti ~ri~'1 ~~~ioQr~el,1'j\ ~1tlAQ,~ G'OI~~,
veJlltl .. ~, ' i; *taik~in j\P!e'l.vv)lll{l d>lWarding .an amount equal to the Total Due as
speclflel'l on the tra IC ifBtio~ J'1!!lUlt II( ~yoplea being recorded.

C rcc.go MofcyCooch v: Ch'COCjD;lf9AJfZJ.~

a. I plead NOT GUlL TV and request a trial _
Signature

b. I plead GUILTy _
Signature

PLEASE PLACE THE CITATION NUMBER

ON YOUR CHECK OR MONEY ORDER.

DO NOT SEND CASH!