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1. Ticket #
2. Circuit Court
3. Court Address
4. Court Date
5. Court Phone
6. Court Time
7a. Last Name
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7b. First Name
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8. Home Address
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9. City
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11. Zipcode
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12a. Date of Birth
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12b. Current Age
12c. DL Number
12d. CDL?
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13. Notes on Your Offense
14a. Driving
14b. Posted Speed Limit
15. Seat Violation
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