92 Ill. Adm. Code 450.APPENDIX A
A Illinois Citation and Complaint
Section 450
Section 450.APPENDIX A
Illinois Citation and Complaint
C/C
No. 1753
#1
COMPLAINT
VEHICLE
INSPECTION COPY
Hearing Docket No.
State of Illinois
County of
City or Township of
People of the State of
Illinois, Plaintiff v.
Name
Defendant
Certified Mechanic
Owner/Operator
Lane Name
Address
City & State
Veh. Test. Station No.
Certified Mechanic Permit No.
The undersigned says that on
/
/
Month
Day
Year
at
a.m./p.m. defendant did
unlawfully:
Violate Section
of the Illinois Vehicle Code
in that he:
Violate Section
of the Illinois Rules &
Regulations Inspection
Manual in that he:
Dated
/
/
Month
Day
Year
Inspector's Signature
I.D. Number
If you choose to appear to
answer to the above charges, report to:
on
/
/
/
at
a.m./p.m.
Month
Day
Year
In the event I fail to appear,
I hereby consent to the entry of an exparte judgment against me and
assessment of whatever fines or determination may be assessed against me.
Signature
Title