29-111 (9) a �
CITY OF NORTHAMPTON NOTICE OF VIOLATION
OF CITY ORDINANCE RULE OR REGULATION
DATE OF THIS NOTICE
NAME OF OFFENDER. e_vz�
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MY OPERATOR LICENSE NUMBER VEHICLE REGISTRATION NUMBER
OFFENSE: Q
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TIME AND DATE OF VIOLATION f
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SIGNATUR RC EN CING E RTME�NT
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THE NONCRIMINAL FINE FOR THIS OFFENSE IS$_1 Q
YOU HAVE THE FOLLOWING ALTERNATIVES IN THIS MATTER:
Either option(1)or option(2)will operate as a final disposition,with no resulting criminal record.
(1)You may choose to pay the above fne, either by appearing in person or
through a duly authorized agent or by mailing a check, money order or postal note
WITHIN 21 DAYS OF THE DATE OF THIS NOTICE to:
Northampton City Clerk
210 Main Street
Northhamplon,MA 01060
(2) If you desire to contest this matter, you may do so by making a written
request for a noncriminal hearing, and enclosing a copy of this citation, WITHIN 21
DAYS OF THE DATE OF THIS NOTICE to
Clerk-Magistrate
Northampton District Court
15 Gothic Street
Northampton,MA 01060
Attn:21D Noncriminal Hearings.
(3)If you fail to pay the above fine or to request a hearing within 21 days,or if
you fail to appear for the hearing or to pay any fine determined at the hearing to be due,
a criminal complaint may be issued against you.
❑1 HEREBY ELECT THE FIRST OPTION above,confess the offense charged,and
enclose payment in the amount of$
❑I HEREBY REQUEST A NONCRIMINAL HEARING on this matter.
Signature
CITY CLERK'S COPY