Indiana Code - Motor Vehicles - Title 9, Section 9-30-3-6

Information and summons; form and content

Sec. 6. (a) In traffic cases, the information and summons shall be
in substantially the following form:
In the _________ Court of __________ County
Cause No. _________ Docket No. ___________

Page No. _____
State of Indiana

SS: No.___________
County of _______________________________

INFORMATION AND SUMMONS

The undersigned having probable cause to believe and being duly
sworn upon his oath says that:
On the ____________ Day of __________, 20 ____ at ____ M
Name ____________________________________________

Last First Middle

Street ________________________________________________
City ______________________ State _____ Zip Code ______
Race ___ Sex ___ Age ___ D.O.B. ______ HT ____ WT _____
Oper. Lic. #_____________ St. ____ Did Unlawfully
Operate Veh. Color _______ Veh. Yr.___ Veh. Make ______

Veh. Lic. Yr. ____ Veh. Lic. St. ____ Veh. Lic. # ______

Upon, (Location) _____________________________________
__________________________________________________

A PUBLIC STREET OR HIGHWAY IN ________________
COUNTY, INDIANA, AND COMMIT, THE OFFENSE OF:
_______________________________________________________
_______________________________________________________
CONTRARY TO THE FORM OF THE ( ) STATE STATUTE
( ) LOCAL ORDINANCE IN SUCH CASE MADE AND
PROVIDED.

OFFICER'S SIGNATURE ___________________________
I.D. No. ______________ Div. Dist. _______________________
POLICE AGENCY _______________________________________
Subscribed And Sworn to Before Me
(Deputy Clerk) ______________________________________
This ____________ Day of _________________, 20 ____

COURT APPEARANCE

I PROMISE TO APPEAR IN COURTROOM
__________________________________________________
ADDRESS: ______________________________
ON ______________ THE ________ DAY OF_________, 20 ___
AT __ M. OR BE SUBJECT TO ARREST.

SIGNATURE __________________________________________
"YOUR SIGNATURE IS NOT AN ADMISSION OF GUILT"

The information and summons shall consist of four (4) parts:
(1) the original copy, printed on white paper, which shall be
the abstract of court record for the Indiana bureau of motor
vehicles;
(2) the court copy, printed on white paper;
(3) the police record, which shall be a copy of the information,
printed on pink paper; and
(4) the summons copy, printed on white stock.

The reverse sides of the information and abstract of court record
shall be substantially as follows, with such additions or deletions as
are necessary to adapt the form to the court involved:

RECEIPT #_______________
DATE ___________________

COURT ACTION AND OTHER ORDERS
BAIL $ ___________

REARREST BOND $ _____________ DATE ___________
1. CONTINUANCE TO ___ 4. CONTINUANCE TO ____
2. CONTINUANCE TO ___ 5. CONTINUANCE TO ____
3. CONTINUANCE TO ___ 6. CONTINUANCE TO ____
Motions Date Ruling Date

1. ___ ___ ___ ___
2. ___ ___ ___ ___
3. ___ ___ ___ ___
4. ___ ___ ___ ___
PLEA ( ) GUILTY

( ) NOT GUILTY

FINDING ( ) GUILTY
( ) NOT GUILTY

THE COURT THEREFORE, ENTERS

THE FOLLOWING ORDER
FINE $ _________ AMOUNT SUSP. $ _________

(STATE) $ _____________
COSTS

(CITY) $ ______________
___________ DAYS IN __________________ DAYS SUSP.
__________
( ) RECOMMENDED LICENSE SUSPENDED FOR _______
( ) PROBATIONARY LICENSE AUTHORIZED FOR ONE YEAR
PROBATION

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
JUDGE: ______________________________________________
DATE: ______________________________________________
ATTORNEY FOR DEFENDANT _________________
ADDRESS________________________ TELEPHONE _________

WITNESSES
_________________________________________________
_________________________________________________

The notice, the appearance, the plea of either guilty or not guilty,
and the waiver shall be printed on the summons. The trimmed size of
the paper and stock on which the form is printed shall be nominally
four and one quarter (4 1/4) inches by eight and one quarter (8 1/4)
inches.
(b) In civil traffic cases, the complaint and summons shall be in
substantially the following form:
In the ____________________ Court of _______________ County
Cause No. ______________ Docket No. ________________

Page No.__________________________

State of Indiana

SS: No._____________
County of ______________________________________

COMPLAINT AND SUMMONS

The undersigned having probable cause to believe and being duly
sworn upon his oath says that:
On the ____________ Day of___________, 20 ____ at __ M
Name _________________________________________________

Last First Middle

Street _____________________________________
City ________________________ State _____ Zip Code ________
Race ___ Sex ___ Age __ D.O.B. ________ HT ____ WT ___
Oper. Lic. # ____________ St. ______________ Did Unlawfully
Operate Veh. Color _______ Veh. Yr. ___ Veh. Make _________
Veh. Lic. Yr. ____ Veh. Lic. St. ____ Veh. Lic. # _________
Upon, (Location) _____________________________________
______________________________________________________
A PUBLIC STREET OR HIGHWAY IN ____________________
COUNTY, INDIANA, AND COMMIT, THE OFFENSE OF:

__________________________________________________
__________________________________________________
__________________________________________________
CONTRARY TO THE FORM OF THE ( ) STATE STATUTE
( ) LOCAL ORDINANCE IN SUCH CASE MADE AND
PROVIDED.

OFFICER'S SIGNATURE ___________________________
I.D. No. _____________ Div. Dist. _______________________
POLICE AGENCY _________________________________
Subscribed And Sworn to Before Me
(Deputy Clerk) __________________________________________
This ____________ Day of ______________, 20___

COURT APPEARANCE

I PROMISE TO APPEAR IN ________________________
COURTROOM ___________________________________
ADDRESS: ______________________________________
ON ____________ THE ________ DAY OF ____, 20 ___

AT __ M. OR BE SUBJECT TO ARREST.

SIGNATURE _____________________________________
"YOUR SIGNATURE IS NOT AN ADMISSION OF A
VIOLATION"

The complaint and summons shall consist of four (4) parts:
(1) the original copy, printed on white paper, which shall be
the abstract of court record for the Indiana bureau of motor
vehicles;
(2) the court copy, printed on white paper;
(3) the police record, which shall be a copy of the complaint,
printed on pink paper; and
(4) the summons copy, printed on white stock.
The reverse sides of the complaint and abstract of court record
shall be substantially as follows, with such additions or deletions as
are necessary to adapt the form to the court involved:

RECEIPT #_________
DATE ________________

COURT ACTION AND OTHER ORDERS
BAIL $ _______________

REARREST BOND $ _________ DATE _______
1. CONTINUANCE TO ______ 4. CONTINUANCE TO ______
2. CONTINUANCE TO ______ 5. CONTINUANCE TO ______
3. CONTINUANCE TO ______ 6. CONTINUANCE TO ______
Motions Date Ruling Date

1. ___ ___ ___ ___
2. ___ ___ ___ ___
3. ___ ___ ___ ___
4. ___ ___ ___ ___
PLEA ( ) ADMIT

( ) DENY
( ) NOLO CONTENDERE
FINDING ( ) JUDGMENT FOR PLAINTIFF

( ) JUDGMENT FOR DEFENDANT

THE COURT THEREFORE, ENTERS
THE FOLLOWING ORDER

FINE $ ________ AMOUNT SUSP. $ ________

(STATE) $ __________
COSTS

(CITY) $ ___________
( ) RECOMMENDED LICENSE SUSPENDED FOR ________
( ) PROBATIONARY LICENSE AUTHORIZED FOR ONE YEAR
PROBATION

______________________________________________
______________________________________________
______________________________________________
______________________________________________
_______________________________________________
JUDGE: _________________________________________
DATE: __________________________________________
ATTORNEY FOR DEFENDANT ____________________
ADDRESS ___________________ TELEPHONE __________

WITNESSES
_______________________________________________
_______________________________________________
The notice, appearance, plea of either admission, denial, or nolo
contendere shall be printed on the summons. The trimmed size of the
paper and stock on which the form is printed shall be nominally four
and one quarter (4 1/4) inches by eight and one quarter (8 1/4)
inches.
(c) The complaint form shall be used in traffic cases, whether the
charge is made by a law enforcement officer or by any other person.
(d) Each judicial officer or police authority issuing traffic
complaints and summons:
(1) is responsible for the disposition of all the traffic complaints
and summons issued under the authority of the officer or

authority; and
(2) shall prepare and submit the records and reports relating to
the traffic complaints in the manner and at the time prescribed
by both the state examiner of the state board of accounts and the
bureau.

As added by P.L.2-1991, SEC.18. Amended by P.L.93-1991, SEC.2;
P.L.1-2001, SEC.8.

Last modified: May 27, 2006