CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2024 JUL 29 PM 5:54
TO PERSON OR PROPERTY
RECEIVED
CITY CLERK
1. Claims for death, injury to person, or to personal property must be filed not later than six (6) months after the occurrence (Gov. Code 59112).
2. Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code §911.2). RETURN TO:
3. READ ENTIRE CLAIM FOR BEFORE FILING Rialto City Clerk's Office
4.ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Mail: 150 S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
-
FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
BUSINESS ADDRESS INCLUBING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
06/29/23 TIME: 11:02 I AM O PM
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: -
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks. at 53 riverside Not Light Sile of strat"Rratto-sen Bernalno Avala pulled over into
3. HOW DID DAMAGE OR INJURY OCCUR?
Requesting impound rsinburment on 00ka/23. yehicle was
taken impounded for 30 days. Case is eleured with su ponchos or arr
4. WERE POLICE AT THE SCENE? EYES DINO
5. WHAT PARTICULAR ACT OR OMISSION DO YOU CLAIM CAUSED THE INJURY OR DAMAGES? Give the name of the city/town employee causing the injury or damage, if known.
rialto -San Bernardino. The cause in a police otticer
pulling no over
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ S 477,80 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
06/20/23 Amount: $ 2,477,80
Item/Date:
Item/Date: 10/05/25 Amount: $ 3,000.00
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 5,477.80 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Amount: $_
Item/Date: Amount: $_
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $ 5,477.80
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: afticer mooner 01323 NAME:
ADDRESS: Rialto so lice department ADDRESS:
125 N willow Ave Riotto CA, 92376
TELEPHONE: (909) 820-2550 TELEPHONE: | )
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: L)
DATE: TIME: ПАМ ПРМ DATE: TIME: DAM PM
9. PLEASE READ THE FOLLOWING CAREFULLY:
For all vehicle accident claims, place on the following diagram, the names of streets, including NORTH, EAST, SOUTH AND WEST directions. Indicate place of accident by "X" and by showing house numbers or distances to street comers.
If a citytown vehicle was involved, designate by letter "A" location of the City/Town vehicle when you first saw it, and by "B" location of yourself or your vehicle when you first saw City/Town vehicle; location of City/Town vehicle at time of accident by "A-1" and location of yourself or your vehicle at the time of the accident by "B-1" and the point of impact by "X".
→ NOTE: IF THE DIAGRAM BELOW DOES NOT FIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIGNED BY THE CLAIMANT.
CURB
PARKWAY
7 SIDEWALK
HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS HOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRU I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
hear Quintana 7/29/24
orat
TYPE OR PRINT NAME DATE
self"
RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376 I Jonathan Quintana,
Present my case of dismissal for the reimbursement of my vehicle being impounded for 30 days. Including the attorney fees I had to go through to prove the unlawful traffic violation.
The violation of the ticket & property happened on 06/29/23 however my case was recently dismissed as of 05/21/24 which is why I am submitting my claim of reimbursement at this time and not when the violation happened, now that I have proof of dismissal. As of the dismissal date | should be within the 6 month deadline. It was a long outgoing case & I could not have submitted this form without proven innocent until the case had been dismissed. Please reach out if any questions, thank you..
CITY CLERK RECEIVED 2024 JUL 29 PM 5:54 CITY OF RIALTO
BE CONT OF CAN SUPERIOR COURT OF CALIFORNIA,
COUNTY OF SAN BERNARDINO
Rancho Cucamonga District
8303 Haven Avenue
Rancho Cucamonga, CA 91730
www.sb-court.org
MINUTE ORDER
Case Number: MWV23010168 Date: 5/21/2024
Case Title: People of the State of California vs. JONATHAN SEVAN QUINTANA Department Ra - Rancho Cucamonga Date: 5/21/2024 Time: 8:30 AM Pretrial Charges: VC23109(A)-M, VC23103(A)-M
Judicial Officer: Joni I Sinclair
Judicial Assistant: Julie Francis
Court Reporter: Recorded Electronically
Bailiff: Deputy S Whitley
Minutes updated by Claudia Sevilla
9:34 AM
9:35 AM
Appearances
District Attorney Carlos Vargas present CITY CLERK RECEIVED 2024 JUL 29 PM 5:54 CITY OF RIALTO Retained Attorney Randy Sarmiento present
Pursuant to Section 977 PC, counsel present without Defendant.
Proceedings
Defendant has completed all conditions set by the People for dismissal.
Upon Motion of the People: case dismissed
Dismissal
As to Count 001. VC23109(A)-M: Speed Contest On Highway, a Disposition of Dismissal/Stricken - Motion of the People is entered.
As to Count 002. VC23103(a)-M: Reckless Driving, a Disposition of Dismissal/Stricken - Motion of the People is entered.
Custody Status
Case Custody - Released
== Minute Order Complete ==
**Minute Order printed
ertificate of Electronic Recording Monitor Printe
ertificate of Electronic Recording Monitor Form printe
CRIMINAL DEFENSE RETAINER AGREEMENT
ineres dorsigned thereinater "Clien" hereby relaine and employs the Law Office of Randy Sarmieno, hereinafter "Alloney," to provide advice and counsel andlor represenation to the Client Name: Jonathan Quintana, with reference to:
Reckless Driving, Speed Contest - Rancho Cucamonga gleese fog** - will consider doing it down the road This contract is required by Business and Professional Code Section 6148, and is intended to fulfill the requirements of that section. lice Arrangement
As compensation for Allomey services, commitment and representation 1, the undersigned client, understand that I am paying a falfc of 4100 oll Client understands that the entire fee outlined above is a NON-RERUNDABLE TRUE RETAINER and shall be considered camed when this relainer agreement is signed. Altorey shall be refusing to handle oher legal matters from other possible clients due to this NON-REFUNDABLE TRUE RETAINER agreement being enered into. Alumey shall be selling aside time in handle this legal maller specifically because this relainer agreement is being entered into. It is for those reasons that the parties agree that Allomey has earned the enter fee amount outlined above upon this retainer agreement being signed. I understand that the flat fee will not coxcr the following:
(1) A trial either bench or jury in the matters), and
(2) An appeal, including an interlocutory appeal, and
3) Any other expenses required for representation in the matters). The amount for which the undersigned client (and any other party designaled as jointly and severally responsible for payment of the fee is responsible under subsections (I) through (3) shall be determined by agreement of the parties and said amount is hereby incorporaled into this contract.
If the undersigned allomey determines that a trial is necessary to resolve the maiters), then a meeting between the attorney and client will occur. The attorney and client will delermine the additional fee neccafe for all aspects of trial preparation and ihe actual trial of the matters), such as whether to proceed to trial, and so This reement will no take effect, and Allormey will have no obligation to provide legal services, uni Client return a signed copy of this Agreement and pays the fixed fee above Payment Plan
If applicable and agreed by both parties, any fee agreed to under paragraph may be paid under a payment plan. The undersigned attorney shall determine the amount of: (1) the initial down payment; and 2) regular installment payments. The undersigned client (and any ather party designated as jointly and severally responsible for payment of the fee has a continuing duty and obligation to make payments as required by the payment plan. The terms of the payment plan are hereby incorporaled into this contract and failure of the responsible party or parties to abide by the lens of the payment plan allows the undersigned attomey and Law Offices of Randy Sarmiento 1o sithdkes from the case(s).
Client shall be respon br the above flat fee under the terms and conditions set forth below regardless of the ulcome of the case and/or if the case FILED, REJECTED due to Altorey's efforts.
The amounts required to be paid under the installment provision of the payment plan must be paid no later than 4:00 pm on the days that the money is owed, unless alternate terms are agreed to by the parties and attached and incorporated into this contract. Oml agreements or subsequent modifications of the contract regarding a payment plan under this subdivision are void and umenforceable. Additionally, Lee Aw Offices of Randy Sarmiento may withdraw as altorneys of record if the client falls two (2) or more payments behind on any payment plan thai has been sel up in the contraci.
Substantial Performance
The parties agree that undenaking any of the following by Automey constitutes "Substantial Perfermance" for contract purposes and as defendant's attomey of record: negotiating for a disposition of client's case, litigating an issue on client's behalf, litigating a source of bail or a bail reduction motion, developing defenses or an investigative plan and directing the defense investigation performed by Allomey in connection with client's case. Any legal services rendered by Allomey on behalf of Client prior to the execution of this. Cement shall be considered for purposes of delermining whether or not there has been substantial performance and are included in the service compensated under this agreement.
Rules of Professional Codnet, Rule 1.15:
A flat fee paid in advance for legal services may be deposited in a lawyer's or law fin's operating account, provide: I) the lawyer or law firm* discloses to the client in writing* (i) that the client has a right under paragraph (a) it require that the flat fee be deposited in an identified trust account until the fee is earned, and in (il) that the client is entitled to a refund of any amount of the fee that has not been eamed in the event the representation is terminated or the services for which the fee has been paid are not completed; and (2) if the fal fce exceeds SI. Ul the client's agreemen: to deposit the fal fee in the lawyer's operating account and the disclosures required by paragraph (b)(1) are set forth in a writing" signed by the client.
Elat Fee Agreement - Costs and Expenscs
Client is to pay for all costs and/or expenses. Such expenses include, but are not limited to: depositions and court reporting services, toxicology records, transcript fees, video and intake photograph copying fees, medical records, driving records, Circuit Court filing fees, private investigalor fees, expert witness fees, and accident reconstruction fees, which may be regin day reed unimage competent counself choice, but fee for such associates will he Autorey's sole responsibility. I agree that all fees will be satisfied within 30 days of receiving an invoice from this attorney's office.
Participation er Assistance of Other Attorncy
i, the undersigned client, agree that an altomey: (I) other than the undersigned attorney; and (2) who is employed by the Law Offices of Randy Sarmiento.; may, without prior approval, render any of the following services lo assist in the resolution of the legal malter(s) for which the undersigned allomey was relained: (1) appearances al pre-trial hearings; (2) panicipation in a urial; (3) assistance with legal research or our f -of-court mallers; (4) conducting depositions; (5) any other maller necessary to assist in the resolution of the legal mallers) for which the undersigned attorney was relained.
No Promisss or Guacentess of Case Outcoms
Client acknowledges thai Allomey has made no promises concerning the outcome of the case, and Allomey's foes are in no way contingent thereon. Client understands that willful failure or neglect to pay Allorney's fees/expenses as agreed shall constitute grounds for Allomey to withdraw from the case. On occasion, Client may ask the opinion as to the culcome of a case. If the allomey chooses to opine as to the possible outcome, I understand that the allorney can never know for sure what the outcome will be in any case, but may (from experience with the particular judge, prosecutor, or type of case) be able to give an educated opini lo a range of possible outcomes. However, I agree that Law Offices of Randy Sarmiento cannot and will not promise or guaraniee that any predicted outcome will occur.
Cient's Responsibilitics
1, the undersigned client, agree to inform the staff of the Law Offices of Randy Sarmiento of any and all address, email, facsimile number, mobile phone number, and other telephone number changes, to appear on reasonable notice for office appointments and court appearances, and to comply with all requests made by the undersigned attorney in the preparation and preseniation of the legal matters). 1, the undersigned client, understand that it is my responsibility to contact the undersigned attorney or staff wilh any questions and concerns relating to , the undersigned client, agree to thoroughly read and review each and every document provided by the undersigned attorney, as it is received or as soon as possible thereafter before indicated by said documents and to communicate with the attorney with questions in the time frame outlined in said document, os% l and request additional time to respond when needed. I agree to complete and deliver to the altorney all requests quickly and thoroughly as requested by the allomey or staff.
Termination of Contract
t, the undersigned client, undersiand that termination of this contract is reserved by the undersigned altomey for reasons such as: non-payment of fees, costs, or expenses when due, or relainer on demand; lack of communication or cooperation; and subsequent determination of non-merit or personal conflict preventing effective representation. 1, the undersigned client, understand that I may cancel this apreement at any lime, for any reason, without necessity of any reason, by notifying the allomey in writing to immediately terminate representation in proof of service, to become effective. No refund will be provided upon termination by client and/or Allomey. my case and to prefum no funer legal services on my behalf. This mule mudi be in writing, dated and signed by lf, sand must be flated or hand diel vered io the atlarney, with Hourty Rate:
ite is $400 per hour and the flat fee above is voidable and Allorney maintains the right to quantum meruit recovers hould CHent discharge Auorney or Alsomey withdraws as discussed above, or in the event of fee dispute, Client ackeredges, agrees, and understands that Auomey's regular hourl CHent Elle
Inless Client notifies Automey in wring to their file, Allomey will maintan Chient's file for 3 years after yefit or disposition of the case and Client thereafter permis Allomey L estroy Client's file pursuant to California law and specifically the Code of Professional Responsibility Cle iN A l re i EN roma our HAVE RAD AND UNDERSTAND THE FOREGOING, INCLUDING MY RIGHT AND Other. Terms end/or Conditions
A down payment of $1,000 will be made today Oclober 2, 2023 for the queted amouni of $3,000. Monthly payments of $500 will be made each month slarting November 02, 2023 therein till balance paid in full.
Dated: 07/10/2024 Client Signature: T75
Dated: 07/10/2024 Allomey Signatre: Sarmiento
Customer Service 1-855-378-6467 Page 2 of 3
www.citicards.com
TTY:711
JONATHAN QUINTANA
CARDHOLDER SUMMARY
JONATHAN QUINTANA
New Charges $3,692.75
BLANCA ARRIOLA
New Charges $0.00
ACCOUNT SUMMARY
Sale Paid Descripion Amount
Payments, Credits and Adjustments
07/21 ONLINE PAYMENT, THANK YOU -$200.00
07/24 AUTOPAY 200630031640760RAUTOPAY AUTO-PMT -$50.00
07128 ONLINE PAYMENT, THANK YOU -$2,050.00
JONATHAN QUINTANA
Costco Cash Rewards
Earned This Period
4% cash back on eligible gas and electric
......+$16.84
3% on restaurants. +$9.49
3% on eligible travel worldwide. +$0.00
2% on Costco and
Costco.com.... ..+$0.38
1% on all other
purchases. ..+$29.37
...... ...
07/28 07/28 PEPES TOWING SERVICE RIALTO CA 1$2.261:00
07/28 07/28 CITY OF RIALTO 909-8202544 CA S216:80 Total Earned: $56.08 .--.•-_.
BLANCA ARRIOLA
No Activity » Visit citi.com/Costco
for more information
Fees Charged
TOTAL FEES FOR THIS PERIOD $0.00 'Up to $7,000 per year in purchases, then 1% cash back
CITY OF RIALTO POLICE DEPARTMENT
Date of Violation NOTICE TO APPEAR IX MISDEMEANE:
06/29/2023 Time XI TRAFFIC LINONIRAFFIC
11:02 Day of Week RIA504241
Name (Fist, Middle, Last) (Company) Thursday Case No.
JONATHAN SEVAN QUINTANA 19323-07128
Address D]Owner's Responsibility (VC 40001)
15531 SUNNY VISTA RD
City
VICTORVILLE State
CA ZiP Code
92394 •tivenile (Phone No.)
State
CA Class "Commercial
Sex Age
M /Eyes Height CM1 D]Yes [XI NO 22
BLK HAZ
Yet. Lis Min ... IN 604 Weight | Race Other Description 222 Hispanic
State
Make CA
Model
CHEVROLET Body Style ] COMM. VEN
None financal Responsole CORVETTE Color (VC 15210(b);
2 DOOR
BLACK
Registered Owner of Lessee
Address
rity •Same as Driver
State
D] Construction Zis.= ZIP Code
•Same as Driver
Correctable Violation eve 1051 Desertion Yes/No Code and Section •School Zone N •Booking Required (see below)
VC 23109(A) ...Speed Contest On Huy Misdemeanor
N VC 23103(A)
or infraction
Reckless Driving M
IXI
Speed Approx.
PF. Max Sod.
510422 IVeh. Lmt.
Location Of Violation(s) 50 TLASER
50 at SB RIVERSIDE 571 ] Continuatic
N of AYALA orm issue
Comments (Weather, Road & Traffic Conditions) Riaito - San Bernardin Ity/County of Occurrenc [Violation (s) not committed in my presence, declared on information and belief. • Accident and correct.
06/29/2023 I declare under penalty of perjury wader the laws of the State of California that the foregoing is true Dec. Date MOONEY
Arresting or Citing Officer 01323
Dec. Date
Name of Arresting Olicer, # different from Citing Officer Serial No. * signature INDICATED BELOW. SerialNo.
EMERA SON IT ONE TO AREA AT THE TOTE AND PRASE
WHAT TO DO: FOLLOW THE INSTRUCTIONS BELOW. WHEN: On or before: 10/03/2023 8:00AM WHERE: Superior Court Rancho Cucamonga District Bans Haven Avenu • To benotified 909) 350C7mnga CA, 91730
New 06-26-15 (VC 40500(b)). dis Counciof Colf orria Form PC 053.9 and 759.1) TR-135 40613(6), 40522, and 40600;
LOCAL INFORMATION FOR THE CITATION IS AVAILABLE ONLINE AT WWW.SB.COURT.ORG
WARNING: If you fail to appear in court as you have promised, you may be arrested and punished IMPORTANT - READ CAREFULLY (Veh. Code sec 40508 or Pen. Code sec 853.7.). In addition, any person who fails to appear as provided by 6 MONTHS INJAIL ANDIOR A $1,000 FINE regardless of the disposition of the original charge.
Vehicle Code section 40903(a) upon any alleged infraction. as charged by the arresting/citing officer. by law may be deemed to have elected to have a trial by written declaration (in absentia) pursuant to with your parent or guardian. JUVENILE: I/youwere under age 18 at the time the citation was issued, you must appear in court the required deposit of money (bail) that may be forfeited instead of your appearing in court. Ifyou do not COURTESY NOTICE: A courtesy notice may be mailed to the address shown on your citation, indicating receive such courtesy notice, you are still required to comply with the items below by the appearance date. ou are required to WHAT TO DO
* Pay the fine (ball). cases, you must do one or more of the following for each violation:
• Appear in court. *Request traffic school (traffic cases, when applicable). •Correct the violation (traffic cases, when applicable) * Contest the violation.
Ityou do not do one of the above actions, then a "failure to appear" charge will be filed againstyou (Veh. *Request trial by written declaration (traftic cases). may be charged an anount in addition to the boil amount and tire cast may be turned over to a collection Code, sec 40508(a)) and your driver license may be withheld, suspended, or revoked. In some courts you agency. (Pen. Code sec 1214.1.)
1. Ifyou do NOT contest the violation:
a.) (Pay the ball amount) Contact the court for ball information. You will not have to appear in court. You will be convicted of the violation, and It will appear on your record at the Department of Motor Vehicles b.) (Traffic school) You may be able to avold the point count by completing traffic school, You must pay the (DMV). A point count may be charged to your DiV record and your Insurance may be adversely altected. ball amount as a fee, and you may have to pay other fees. Contact the court to request traffic school. c.) (Correctable violations) If the "Yes" box is checked on the front of your ticket, the violation is installation station agent sign below. (Veh. Code, sec 40616.) Registration and driver license violations may correctable. Upon correction of the violation, have a law enforcement officer or an authorized inspection/ will be dismissed by the court after PROOF OF CORRECTION and payment of a transaction fee are presented also be certified as corrected at an office of the DMV or by any cierk or deputy clerk of a court. The violation lability insurance) will be dismissed only upon (1) your showing or mailing to the court evidence of tinancial to the court by mail or in person by the appearance date. Violations of Vehicle Code section 16028 automobile responsibility valid at the time this notice to appear was issued, and (2) your payment of a transaction fee.
CERTIFICATION OF CORRECTION (MUST BE RETURNED TO COURT) Section(s)
Violated Signature of Person Serial No.
Certifying Correction Agency
Date
2. Ifyou contest the violation (select a or b):
appearance date or come to the court by the appearance date to request a court trial on a future a. (Court Trial) Send a certified or registered letter postinarked not later than five days prior to the amount. Go online or call the court for information on going to court without paying bail date when an officer and any witnesses you bring will be present You may be required to submit the bail -OR-
than five days prior to the appearance date or come to the court on or before the appearance date to b. (Triat by written declaration (traffic infractions)) Send a certified or registered letter postmarked not later a statement and to submit other evidence without appearing in court. An officer will aiso submit a statement. request a trial by written declaration. Submit the bail amount. You will be given forms to allow you to write The Judicial officer will consider the evidence and decide the case.
3. Make check/money order payable to Clerk of the Court. Write your citation number and driver license number on your check or money order. You may pay in person, by mail or by phone.
4. It "Booking Required" is checked you must appear for booking on a teekday prior to your court date at between the hours of and and bring
the signed verilication to your court appearance.
BOOKING VERIFICATION: I declare under penalty of perjury under the laws of the State of California that Defendant's name Was booked on a
Officer 'Serial No.
CERTIFIED COPY
STREET ADDRESS 8303 N Maven Ave
HAUNG ADDRESS
Rancho Cucamonga Ca 91730 Original to court
BRANCH NAME Criminat
TELEPHONE 909-045-4313
PEOPLE OF THE STATE OF CALIFORNIA Victorville, Ca 92394 15531 Sunny Vista Rd [Jonathan Sevan Quintana Date: 06-29-23 S. Mooney DEFENDANT: Jonathan Sevan Quintana Defendant's Address;
NOTICE OF CORRECTION AND PROOF OF SERVICE
(Vehicle Codo, 540505)
AMENDING OFFICER NAMEND HO•
S. MOONEY - 01323 Rialto Police Department
THERER
RIA504244 Rialto Police Department 128 N. Willow Ave Rialto, CA 92376 (Type or print name)
1.A Notice to Appear/Notice to Correct Violation was issued to you by an officer of this department on (dato): 06/29/2023
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 I declare under penally of perjury under the laws of the State of Califormia up the foregoing is true and correct. appearance.
Date/time of violation should be
Date/time of court appearance should be changed
10/5/23 6:00 _ 10 10/24.23 9:00
Violation section(s) should be changed
(SIGNATURE)
Location of violation should be changed
from
Other (specify) Speed to read at 92 MPHw/distanc
590 FE
Ideclare under penally of penury under the laws of the State of Catfomia that the foregoing is true and correct. 4.
Dase: 06-29-23