APPENDIX B: VIOLATION FORM

STATE OF INDIANA   )               IN THE PORTER SUPERIOR COURT

            )   SS:            COUNTY DIVISION

COUNTY OF PORTER   )               SITTING AT VALPARAISO, INDIANA

TOWN OF VALPARAISO, A   )

   Municipal Corporation,         )

   Plaintiff,               )

                     )

vs.                     )            CAUSE NO. ____________________

                     )

__________________________,)

   Defendant.

NOTICE

   Be here advised that the City of Valparaiso now alleges that the defendant listed below violated section __________ of the City of Valparaiso, Indiana on _________ , 20___. Further, that the defendant listed below is granted a court appearance as follows:

         DATE: __________________

         TIME: __________________

         LOCATION:   16 East Lincolnway

                     Valparaiso, In 46383

DEFENDANT NAME (PRINTED) _____________________________________

DEFENDANT SIGNATURE __________________________________________

(Your signature is not an admission of guilt nor of a violation)

DEFENDANT’S CURRENT ADDRESS _________________________________

COURT CONTACT __________________________________________________

(‘89 Code, Traffic Exhibit B) (Am. Ord. passed 4-8-96)