May we use your name for legislative purposes? Yes-Use My Name No - DO NOT use my name ~ Please Select ~

What Happened When You Were Stopped?

When were you stopped? January February March April May June July August September October November December ~ Month ~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ~ Day ~ 2009 2010 2011 2012 2013 2014 ~ Year ~ Time: PM AM ~ Please Select ~   

Location where you were stopped?

Officers name: ID#: Police Agency:

Primary reason for stop: Helmet/Other, please specify:

Was a citation issued? Yes No ~ Please Select ~

Citation#: 1st appearance date: Time: PM AM ~ Please Select ~

Court Location - City/County:

List any other charges issued at the same time:

If there were any criminal charges (not infractions) issued, specify:

If you were charged with a crime you should IMMEDIATELY obtain LEGAL ADVICE!

Did the officer follow normal traffic laws in making the stop? Yes No I think so. I do not know. ~ Please Select ~

If you do not think the officer followed normal traffic laws please explain:

Did officer treat you fairly and respectfully? Yes No ~ Please Select ~

If no, please explain:

Was your helmet confiscated/taken? Yes No ~ Please Select ~

If yes, please explain:

Were you given an explanation on legal or illegal helmets? Yes No ~ Please Select ~

If yes, was the explanation written, verbal or both? Written Verbal Both ~ Please Select ~

If verbal, describe the explanation:

What Happened In Court?

Have you gone to court? Yes No ~ Please Select ~
If you HAVE NOT GONE TO COURT, when is the court date?

If you HAVE GONE TO COURT, how did you plead? Guilty Not Guilty ~ Please Select ~

If you pled GUILTY, what was the fine?

If you pled NOT GUILTY, have you gone to trial? Yes No ~ Please Select ~

If you pled NOT GUILTY AND HAVE NOT GONE TO TRIAL , when is your court date?

If you HAVE GONE TO TRIAL , what was the verdict? Guilty Not Guilty ~ Please Select ~

If you were FOUND GUILTY, what was the sentence?

How much were you fined?

Assessment: State:      County:      City:

Work hours lost:      Lost wages:

Briefly describe the evidence you presented at your trial:

Describe the Helmet You Were Wearing

Brand: Model:

When you bought the helmet did it have a DOT sticker on the outside? Yes No ~ Please Select ~

Was the label permanenetly fastened inside the helmet? Yes No ~ Please Select ~

Was the helmet modified? Yes No ~ Please Select ~

If it was modified please describe the modifications:

Additional Information, comments or questions: