Date: ____________________

Superior Court of California

County of ______________

Court Address: _________________

_____________________________

______________________________

______________________________

Please accept this correspondence as my formal plea of NOT GUILTY and request for a Trial by Written Declaration for the traffic infraction citation referenced below with all relevant information:

My Name:_____________________________

Citation Number:________________________

Citation Date:___________________________

Driver License #:________________________

Telephone #:____________________________

Mailing address:_________________________

____________________________

____________________________

Attached please find a check in the amount of __________ for the bail amount due in full. Please forward all necessary forms for Trial by Written Declaration to the above address.

Sincerely,

__________________________

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