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Court Report UTC-19 - Alabama
| Court Report Form. This is a Alabama form and can be used in Traffic Statewide . |
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State of Alabama Unified Judicial System Form UTTC-19 Rev. 8/09 COURT REPORT TO THE DEPARTMENT OF PUBLIC SAFETY, STATE OF ALABAMA, OF A CONVICTION OR ADJUDICATION REQUIRING SUSPENSION OR REVOCATION OF DRIVERS LICENSE WHERE NO UTTC HAS BEEN ISSUED This Report Contains Confidential Information on a Juvenile or Youthful Offender YES NO CASE NUMBER ALABAMA, COUNTY OF CO CITY AL COURT ORI NUMBER J Month OFFENSE DATE Day Year NAME: First Middle/Maiden Last STATE DRIVER'S LICENSE NUMBER CLASS RACE DATE OF BIRTH Alias, If Known Street Address SEX City State Zip SOCIAL SECURITY NUMBER - PLACE OF OFFENSE City and/or County OFFENSE CHARGED COMMERCIAL MOTOR VEHICLE Yes No Yes No HAZARDOUS MATERIAL INVOLVED CDL REQUIRED Yes Yes No No PASSENGER VEHICLE (requiring passenger endorsement) CONVICTED / ADJUDICATED OF CIRCUIT DISTRICT MUNICIPAL DATE Month Day CODE SECTION / MUNICIPAL ORDINANCE VIOLATED Year FINE COSTS TOTAL Years JAIL TERM Months Days JUVENILE COURT OF Street Address TELEPHONE NUMBER ( )- City State Zip COURT ORDERED SUSPENSION __________________ MONTHS INPATIENT TREATMENT ORDERED Yes No ISSUANCE DATE ______/______/_______ ISSUANCE NUMBER _____ LICENSE DESTROYED (DATE) _____/_______/________ DISTRIBUTION: Part 1 - DPS Reporting Copy Part 2 - Court Record Copy License Attached Yes No I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT ABSTRACT OF THE RECORD OF CONVICTION OF SAID PERSON IN THIS COURT. ___________________________ Date of Report ____________________________________ Judge/Clerk Signature American LegalNet, Inc. www.FormsWorkFlow.com
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