IN THE COUNTY COURT IN AND FOR 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 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 AMERICANS WITH DISABILITIES ACT OF 1990 If you are a person with a disability who needs any accommodation to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact the Dade County Court’s ADA Coordinator at 73 West Flagler Street, Room 1600, Miami, Florida, 33130, telephone numbers 305-375-2006 for voice, 305-375-2007 for TDD and 305-350-6205 or fax, within two (2) working days of your receipt of this document. TDD users may also call 1-800-955-8771, for the Florida Relay Service. 2002 © American LegalNet, Inc.