IN THE COUNTY COURT IN AND FOR MIAMI-DADE COUNTY, FLORIDA Traffic Division - Request for Trial THE STATE OF FLORIDA VS. Defendant Driver's License # Case Number(s) State I request that the citation listed above be set for trial. If it is determined that I have committed an infraction, I understand that the Court may impose a civil penalty not to exceed $500.00 (violations involving a death or speeding in school/construction zones the fine shall not exceed $1,000.00) or require attendance at traffic school, or both, pursuant to F.S. 318.14(5). Driver's License Number Date of Birth ADDRESS CITY APT. STATE ZIP CODE PHONE NUMBER PLEASE CHECK IF ADDRESS IS DIFFERENT FROM THE ADDRESS ON YOUR CITATION. I have read and understand the above, and I hereby acknowledge receipt of a copy of this form. Defendant's Signature Date Mailing Instructions Please printout, complete form, sign, date and mail to: Clerk of Courts Traffic Division P.O. BOX 19321 Miami, Fl. 33101-9321 CLK/CT 894 REV. 10/10 Clerk's web address: www.miami-dadeclerk.com American LegalNet, Inc. www.FormsWorkFlow.com