(CITY NAME) MUNICIPAL COURT

309 W. 20TH St. Room 2100

Cheyenne, Wyoming 82001

City of (CITY NAME),,	)
Plaintiff,	)	Docket #. ___________________
VS.	)	Citation # _________________
(DEFENDANT'S NAME)	)	DOB ____________
Defendant.	)

ABSTRACT OF JUDGEMENT AND SENTENCE OF THE COURT

DEFENDANT INFORMATION

(DEFENDANT'S NAME)
SSN# (SOC. SECURITY. #)
(DEFENDANT'S ADDRESS)	DL# (DL #) STATE (DL STATE)
(DEFENDANT'S CITY, STATE ZIP
SEX (M/F)

OFFENSE INFORMATION

Statute # __________________
Statute Title _______________________________
Offense Date _____________
Location _____________________________________
Speed Zone Posted ________ MPH Over ________
Speed Recorded ______

Officer _________________ of the (CITY NAME) Police Department

VEHICLE INFORMATION

Vehicle Lic # __________ State ____ Make________________ Year ____ Vehicle Type __________________

PLEA AND DISPOSITION

Initial Appearance (DATE) Disposition Date (DATE)	Disposition _________

SENTENCE

Total Fine Amount	$ _________	Fine Waived	$ _________

Total Costs/Victim Compensation	$ _________	Jail Days	___________

Total Bond Forfeited	$ _________	Jail Credited	___________

I hereby certify that this information is a true abstract of the record of this court.

Clerk ______________________________