to complete the necessary information on the form so your payment or request can be applied correctly An additional 10 service fee will be imposed for each dishonored check NAMECITATION WAS WRITTENADD ID: 897862
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1 DISTRICT COURT OF MARYLAND UNIFORM COMPL
DISTRICT COURT OF MARYLAND UNIFORM COMPLAINT AND CITATION OPTION FORM (TRAFFIC CITATION)Return to:Traffic Processing CenterP.O. Box 6676Annapolis, MD 214010676LOSTOR MISSING TRAFFIC CITATION OPTION FORM(FOR USE WITH DR-049 -049E MARYLAND UNIFORM COMPLAINT AND CITATION ONLY)If you lost or misplaced your citation, you will need to complete this blank form, print and mail WITHIN 30 DAYS after receipt of the citation to: to complete the necessary information on the form so your payment or request can be applied correctly. An additional $10 service fee will be imposed for each dishonored check. NAME CITATION WAS WRITTEN : ADDRESS Ch散kf摤r敳sn cit慴i潮 w慳iff敲e湴 C䥔YⰠSTATEⰠZ䥐 T䕌䕐HON䔠NO. CHECK THE APPROPRIATE BOX BELOW. IF MAILING IN FINE, FILL IN AMOUNT OF FINE. PAY FINE AMOUNT $ REQUESTENTER INTOPAYMENT PLAN REQUEST WAIVER HEARING REQUEST TRIAL If you pay the fine or enter into a payment plan, you agree to a guilty disposition for the charge(s) . Check the appropriate box and sign below to request a Payment Plan, Waiver Hearing , or Trial for any citations listed above. Request Request Waiver Hearing - violation(s) charged in this citation. I am requesting a waiver hearing at which I may explain the c ircumstances to a judge.I know this is not a trial, the officer and witnesses will not be present, and that my appearance in court is for sentencing only. DO NOTSEND PAYMENTwith your request Request Trial - I request a trial date for the violation(s) charged. wi th your request . DR - 049O (Rev. 10/2020 ) DEFENDANT’S SIGNATURE DATE Reset