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COMPLAINT Case #: Citation #: T01 T263 111204 104556 7

Form 420001E 1/07 Reference #: IOWA UNIFORM CITATION AND COMPLAINT
PLAINTIFF Law Enforcement Agency - MOTOR VEHICLE ENFORCEMENT
State of Iowa County of: DALLAS - 25A City of:
In the Court at DALLAS COUNTY COURTHOUSE 801 COURT STREET ADEL IA 50003
VS. DL/State ID
HABIBULLAEV
Name SAIPOV SAYFULLO
IC DL# S110788880481 Viewed? YES DOB 2/8/1988
Defendant, Last First Middle Suffix
Address 5241 RED CEDAR DR APT 9 City FT MYERS State FL Zip Code 33907-0000 Race W Ethnicity N
DL State FL DL Class A DL End. NONE DL Rest. NONE Height 5' 07" Weight 120 LBS Sex MALE
The undersigned states that on or about 12/04/2011 at 10:25 AM defendant did unlawfully: Operate Motor Vehicle/Boat 2004 WHI FRHT TT
CDL YES Pass End NO
US DOT# 0208668 ICC# 728198 Lic. Plate #/REG AN115K State NJ Year 2012 HazMat End Req?
Req? Req?
Upon a public highway at I80 WB 113 MM VAN METER Located in the county and state aforesaid and did then and there commit the following offense:
Scheduled Violation/Fine $50.00 Court Appearance Required (805.10) Road Work Zone Non-scheduled Violation Speed in Zone
Criminal Surcharge $17.50
Reason: Serious P.I. Fatal Accident Civil Damage Assessment Other Fed/Adm Code: 395.8F1
Co. Enf. Surcharge N/A
Violation LOG NOT CURRENT LE: 12-03-11/1030HR DRIVE IA Code: 20 11
Court Costs $60.00
Total Fine/Costs $127.50 Sec #: 321.449 ICIS Sec #: 321.449-C Local Ord. ICIS Ord.

I.D. No. T263 NOTICE: Providing false identification information is a violation of Section 719.1A of
Officer's the Code of Iowa and is punishable as a simple misdemeanor.
Signature Dated 12/04/2011
You hereby are given notice that within a reasonable time but no later than the date scheduled for your
Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not initial appearance a citation/complaint sworn under oath will be filed with the district court clerk of the
require an appearance, report to the above named court on: county in which this citation was issued.
12/27/2011 at 9:30 AM

My signature below is not a plea of guilty, but acknowledges all of the following:
1. I hereby swear and affirm that the information provided by me on this citation is true under penalty of providing false information.
2. I promise to appear in said court at said time and place. I understand that a person who willfully fails to appear in court as specified by this citation may be subject to arrest and/or loss of driving privileges.

3. If a court appearance is not required, I may enter a plea of guilty prior to the designated appearance date by delivery in person, or by agent, or by mail to the court specified by this citation.
The following applies to simple misdemeanors only:
4. I hereby give my unsecured appearance bond in the amount of $161.25 dollars and enter my written appearance. I agree that if I fail to appear in person or by counsel to defend against the offense
charged in this citation, the court is authorized to enter a conviction and render judgment against me for the amount of my appearance bond in satisfaction of the penalty and surcharge plus court cost.

*+T01T2631112041045567+*
Dated

X
12/04/2011
Signature of
Defendant

I swear that the foregoing complaint is true and correct. at , Iowa

Subscribed and sworn to me by ALDRIDGE, TERRY VAN METER - 7957
this 04 day of DECEMBER, 2011

Officer's Agency Notary/other Notary/other

Signature Signature
MOTOR VEHICLE ENFORCEMENT OTHER

ABSTRACT OF COURT RECORD

COURT NO. CASE NO.

Citation #:
T01 T263 111204 104556 7
DOCKET NO. CASE NO. TESTIMONY - JUDGE'S NOTES: (Other Orders)
LICENSE NO. STATE: Iowa

FORFEIT BOND Other FILED 12/09/2011 11:46AM

CLERK DISTRICT COURT
BAIL CASH DEPOSIT DALLAS COUNTY IOWA
JURY TRIAL
PLEA VERDICT

GUILTY
NO JURY TRIAL or GUILTY
PROCEEDING NOT GUILTY
NOT GUILTY Date Signature, person giving bail Signature, person taking bail
DISMISSED

Driver's License None School Susp. Revo Days

OTHER DISPOSITION
Recommendation
The court Therefore Enters in Following Order This Date
Mo. Day Yr. DATE: Continued to: REASON

FINED $ SURCHARGE $ COST $ DATE: Continued to: REASON

Incarceration in Days:
DATE: WARRANT ISSUED
TO THE COURT: The following are witnesses who can give testimony relating to the facts of this alleged violation. Please subpoena prosecuting witness:
Name Address Phone