COMPLAINT

Form 420001E 1/07 PLAINTIFF State of Iowa In the Court at VS. Name

Dispatch / Case #:

Citation #: E-FILED 2013 OCT 23 8:25 AM SAC - CLERK OF DISTRICT COURT131023 S81 URNS IOWA UNIFORM CITATION AND COMPLAINT
Law Enforcement Agency SAC COUNTY SHERIFF'S OFFICE City of:

074447 5

Reference #:
County of: SAC - 81

SAC COUNTY COURTHOUSE 100 NW STATE STREET SUITE 12 MELISSA

First DL Class

SAC CITY
DL#

IA

50583
DL/State ID Viewed? YES DOB 6/20/1972 Ethnicity N Sex FEMALE

ROOSE RAASCH
Defendant, Last

ANN
Middle City Suffix

683YY5875
State IA DL Rest. NONE Zip Code Height

Address 1817 290TH ST DL State IA The undersigned states that on or about US DOT# ICC#

ODEBOLT
DL End. L

Race W 51458-0000 5' 04" Weight

10/23/2013

at 7:44 AM

defendant did unlawfully: Operate Motor Vehicle/Boat State

2006 WHI

Lic. Plate #/REG BBT284

Upon a public highway at 310TH ST AND M043/FOX AVE Scheduled Violation/Fine Criminal Surcharge Co. Enf. Surcharge Court Costs Total Fine/Costs

CDL NO HazMat End Req? Req? Req? Located in the county and state aforesaid and did then and there commit the following offense:

IA

Year 2014

CADILLA ESC C - CADI Pass End

SW

$40.00 $14.00 $5.00 $60.00 $119.00

Court Appearance Required (805.10) Reason: Serious P.I. Fatal Accident

Road Work Zone Civil Damage Assessment

Non-scheduled Violation Other

Speed

65

in

55

Zone

Fed/Adm Code: IA Code: 20

Violation SPEED (55 ZONE) 6-10 OVER Sec #: ICIS Sec #: I.D. No. 81-7 Local Ord. 4.5.2/4(1)

ICIS Ord. 4.5.2/4(1)-B

Officer's Signature

Dated 10/23/2013

NOTICE: Providing false identification information is a violation of Section 719.1A of the Code of Iowa and is punishable as a simple misdemeanor.
You hereby are given notice that within a reasonable time but no later than the date scheduled for your initial appearance a citation/complaint sworn under oath will be filed with the district court clerk of the county in which this citation was issued.

Court Date: If you must appear in court or if you choose to appear to answer to a charge which does not require an appearance, report to the above named court on: 11/18/2013 at 8:30 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:

$148.50 4. I hereby give my unsecured appearance bond in the amount of 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.

*+S81URNS1310230744475+*
Dated
Signature of Defendant

X
Subscribed and sworn to me by this

10/23/2013

I swear that the foregoing complaint is true and correct.

23

day of

BURNS, JOEL OCTOBER, 2013

Notary/other Signature

at

ODEBOLT - 5655
Notary/other

, Iowa

Officer's Signature

Agency

SAC COUNTY SHERIFF'S OFFICE

NOTARY

ABSTRACT OF COURT RECORD

COURT NO. DOCKET NO. LICENSE NO. FORFEIT BOND BAIL CASH DEPOSIT PLEA GUILTY NOT GUILTY VERDICT GUILTY NOT GUILTY DISMISSED CASE NO. CASE NO. STATE: Iowa Other

Citation #:

S81 URNS 131023 074447 5

TESTIMONY - JUDGE'S NOTES: (Other Orders)

JURY TRIAL

NO JURY TRIAL or PROCEEDING

Date

Signature, person giving bail

Signature, person taking bail

OTHER DISPOSITION The court Therefore Enters in Following Order This Date
Mo. Day Yr.

Driver's License Recommendation DATE: DATE: DATE:

None

School

Susp.

Revo

Days

Continued to: Continued to: WARRANT ISSUED

REASON REASON

FINED $ Incarceration in

SURCHARGE $

COST $ Days:

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