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Ver m o n t J ud i c i a l B u r e a u P .O . B o x 607 , W h i t e R i v e r Jun c t i on , V erm on t 05001 ( 802) 29 5 - 8869 / JUD .VJB@vermont.gov P O L I C E A M E NDM E N T / V O I D / D I S M I S S A L F ORM D e f en d ant's N a m e De p a rt m e n t # C o m p l a i n t # T h is c o m p l a i n t is h e r e b y d i s m i s se d w ith p r e j ud i ce . T h is c o m p l a i n t is h e r e b y v o i d e d. T h is c o m p l a i n t is h e r e b y a m e nde d as follows : or as set forth below. Waiver of points - all conditions set out in 23 V.S.A. 247 2501(b) are met. ( e n t e r a s n e c es s a ry) In v i o l a t i o n o f : St a te St a t u te Cit a t i o n L o ca l O r d i n a n c e Cit a ti o n C ode A c t u a l/ P o s t e d S p eed Bl o o d A lc oh ol L e v el W a i v e r P e n a lty & S u r c h a r g e $ N o . o f P o i n t s : A cc i d e n t R es u lti n g ? Ye s No F a t a lity R es u lti n g ? Ye s No Cri m i n a l C h a r g e s R es u lti n g ? Ye s No P o li c e S u p e r v i s o r ( f o r d i s m i ssa l) Da te I ss u i n g O f f i ce r Da te I h e r e b y p l ea d to t h e a bo v e a m e nd e d c o m p l a i n t: A d m itted N o C o n t es t D e n ied D e f e n d a n t Da te 500-00702 - Police Amendment Void/Dismissal (0/2017) D i s t r i b u ti o n : Or i gi n al ~ J u d i c ial B ur eau 2n d C o p y ~ D e f e nd a n t American LegalNet, Inc. www.FormsWorkFlow.com
