On (date): , I served this Notice of Correction on the parties at the address listed below by depositing in a sealed envelope, postage prepaid, with the United States Postal Service at (city and state):
I am at least 18 years of age, not a party to this action, and I am a resident of or employed in the county where the mailing took place. My business address is:
Original to Court
Date:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
NAME OF COURT: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: TELEPHONE:
PEOPLE OF THE STATE OF CALIFORNIA vs.
___________________________________________________________________
Defendant's Address:
DEFENDANT:
NOTICE OF CORRECTION AND PROOF OF SERVICE (Vehicle Code, ยง 40505)
AMENDING OFFICER NAME/ID NO.: DEPARTMENT/AGENCY:
(Type or print name)
CITATION NUMBER:
CASE NUMBER:
1. A Notice to Appear/Notice to Correct Violation was issued to you by an officer of this department on (date): 2. The citation issued to you contained an error as indicated by the items checked below. This notice of correction does not affect the validity of the citation or the required court appearance. Date/time of violation should be Date/time of court appearance should be changed
_______________________________________________________________________________
from
to Violation section(s) should be changed
from
(SIGNATURE)
to Location of violation should be changed
from
to Other (specify):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:
(Signature of officer) Form Adopted for Mandatory Use Judicial Council of California TR-100 [Rev. January 1, 2004]