Indiana Code
Chapter 3. Court Procedures
9-30-3-6. Information and Summons; Form and Content; Inapplicability to Electronic Traffic Ticket

Sec. 6. (a) This section does not apply to electronic traffic tickets.
(b) In traffic cases, the information and summons shall be in substantially the following form:
In the _________ Court of __________ County
Cause No. _________ Docket No. ___________
Page No. _____
State of Indiana

SS:
No.___________
County of ______________________________________________
INFORMATION AND SUMMONS
The undersigned having probable cause to believe and being duly sworn upon his oath says that:
On the ____________ Day of __________, 20 ____ at ____ M
Name ____________________________________________

Last
First
Middle
Street __________________________________________________
City ______________________ State _____ Zip Code ______
Race ___ Sex ___ Age ___ D.O.B. ______ HT ____ WT _____
Oper. Lic. #_____________ St. ____ Did Unlawfully
Operate Veh. Color _______ Veh. Yr.___ Veh. Make ______
Veh. Lic. Yr. ____ Veh. Lic. St. ____ Veh. Lic. # ______
Upon, (Location)
______________________________________________________
______________________________________________________
A PUBLIC STREET OR HIGHWAY IN ______________________
COUNTY, INDIANA, AND COMMIT, THE OFFENSE OF:
______________________________________________________
______________________________________________________
CONTRARY TO THE FORM OF THE ( ) STATE STATUTE
( ) LOCAL ORDINANCE IN SUCH CASE MADE AND PROVIDED.
OFFICER'S SIGNATURE _________________________________
I.D. No. ______________ Div. Dist. __________________________
POLICE AGENCY _______________________________________
Subscribed And Sworn to Before Me
(Deputy Clerk) ______________________________________
This ____________ Day of _________________, 20 ____
COURT APPEARANCE
I PROMISE TO APPEAR IN COURTROOM
__________________________________________________
ADDRESS: ______________________________
ON ______________ THE ________ DAY OF_________, 20 ___ AT __ M. OR BE SUBJECT TO ARREST.
SIGNATURE __________________________________________
"YOUR SIGNATURE IS NOT AN ADMISSION OF GUILT"
The information and summons shall consist of four (4) parts:
(1) the original copy, printed on white paper, which shall be the abstract of court record for the Indiana bureau of motor vehicles;
(2) the court copy, printed on white paper;
(3) the police record, which shall be a copy of the information, printed on pink paper; and
(4) the summons copy, printed on white stock.
The reverse sides of the information and abstract of court record shall be substantially as follows, with such additions or deletions as are necessary to adapt the form to the court involved:
RECEIPT #_______________
DATE ___________________
COURT ACTION AND OTHER ORDERS
BAIL $ ___________
REARREST BOND $ _____________ DATE ___________
1. CONTINUANCE TO ___
4. CONTINUANCE TO ____
2. CONTINUANCE TO ___
5. CONTINUANCE TO ____
3. CONTINUANCE TO ___
6. CONTINUANCE TO ____

Motions
Date
Ruling
Date
1.
___
___
___
___
2.
___
___
___
___
3.
___
___
___
___
4.
___
___
___
___
PLEA
( ) GUILTY

( ) NOT GUILTY
FINDING
( ) GUILTY

( ) NOT GUILTY
THE COURT THEREFORE, ENTERS
THE FOLLOWING ORDER
FINE $ _________
AMOUNT SUSP. $ ________

(STATE) $ _____________
COSTS

(CITY) $ ______________
___________ DAYS IN _____________ DAYS SUSP. _________
( ) RECOMMENDED LICENSE SUSPENDED FOR _______
( ) PROBATIONARY LICENSE AUTHORIZED FOR ONE YEAR PROBATION
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
JUDGE: ______________________________________________
DATE: ______________________________________________
ATTORNEY FOR DEFENDANT _________________
ADDRESS________________________ TELEPHONE _________
WITNESSES
_________________________________________________
_________________________________________________
The notice, the appearance, the plea of either guilty or not guilty, and the waiver shall be printed on the summons. The trimmed size of the paper and stock on which the form is printed shall be nominally four and one quarter (4 1/4) inches by eight and one quarter (8 1/4) inches.
(c) In civil traffic cases, the complaint and summons shall be in substantially the following form:
In the ____________________ Court of _______________ County
Cause No. ______________ Docket No. ________________
Page No.__________________________
State of Indiana

SS:
No._____________
County of ______________________________________
COMPLAINT AND SUMMONS
The undersigned having probable cause to believe and being duly sworn upon his oath says that:
On the ____________ Day of___________, 20 ____ at __ M
Name _________________________________________________

Last
First
Middle
Street _____________________________________
City ________________________ State _____ Zip Code ________
Race ___ Sex ___ Age __ D.O.B. ________ HT ____ WT ___
Oper. Lic. # ____________ St. ______________ Did Unlawfully
Operate Veh. Color _______ Veh. Yr. ___ Veh. Make _________
Veh. Lic. Yr. ____ Veh. Lic. St. ____ Veh. Lic. # _________
Upon, (Location) _________________________________________
_______________________________________________________
A PUBLIC STREET OR HIGHWAY IN ______________________
COUNTY, INDIANA, AND COMMIT, THE OFFENSE OF:
__________________________________________________
__________________________________________________
__________________________________________________
CONTRARY TO THE FORM OF THE ( ) STATE STATUTE
( ) LOCAL ORDINANCE IN SUCH CASE MADE AND PROVIDED.
OFFICER'S SIGNATURE ___________________________
I.D. No. _____________ Div. Dist. _______________________
POLICE AGENCY _________________________________
Subscribed And Sworn to Before Me
(Deputy Clerk) __________________________________________
This ____________ Day of ______________, 20___
COURT APPEARANCE
I PROMISE TO APPEAR IN ________________________
COURTROOM ___________________________________
ADDRESS: ______________________________________
ON ____________ THE ________ DAY OF ____, 20 ___
AT __ M. OR BE SUBJECT TO ARREST.
SIGNATURE _____________________________________
"YOUR SIGNATURE IS NOT AN ADMISSION OF A VIOLATION"
The complaint and summons shall consist of four (4) parts:
(1) the original copy, printed on white paper, which shall be the abstract of court record for the Indiana bureau of motor vehicles;
(2) the court copy, printed on white paper;
(3) the police record, which shall be a copy of the complaint, printed on pink paper; and
(4) the summons copy, printed on white stock.
The reverse sides of the complaint and abstract of court record shall be substantially as follows, with such additions or deletions as are necessary to adapt the form to the court involved:
RECEIPT #_________
DATE ________________
COURT ACTION AND OTHER ORDERS
BAIL $ _______________
REARREST BOND $ _________ DATE _______
1. CONTINUANCE TO ______
4. CONTINUANCE TO ______
2. CONTINUANCE TO ______
5. CONTINUANCE TO ______
3. CONTINUANCE TO ______
6. CONTINUANCE TO ______

Motions
Date
Ruling
Date
1.
___
___
___
___
2.
___
___
___
___
3.
___
___
___
___
4.
___
___
___
___
PLEA
( ) ADMIT

( ) DENY

( ) NOLO CONTENDERE
FINDING
( ) JUDGMENT FOR PLAINTIFF

( ) JUDGMENT FOR DEFENDANT
THE COURT THEREFORE, ENTERS
THE FOLLOWING ORDER
FINE $ ________
AMOUNT SUSP. $ ________

(STATE) $ __________
COSTS

(CITY) $ ___________
( ) RECOMMENDED LICENSE SUSPENDED FOR ________
( ) PROBATIONARY LICENSE AUTHORIZED FOR ONE YEAR PROBATION
______________________________________________
______________________________________________
______________________________________________
______________________________________________
_______________________________________________
JUDGE: _________________________________________
DATE: __________________________________________
ATTORNEY FOR DEFENDANT ____________________
ADDRESS ___________________ TELEPHONE __________
WITNESSES
_______________________________________________
_______________________________________________
The notice, appearance, plea of either admission, denial, or nolo contendere shall be printed on the summons. The trimmed size of the paper and stock on which the form is printed shall be nominally four and one quarter (4 1/4) inches by eight and one quarter (8 1/4) inches.
(d) The complaint form shall be used in traffic cases, whether the charge is made by a law enforcement officer or by any other person.
(e) Each judicial officer or police authority issuing traffic complaints and summons:
(1) is responsible for the disposition of all the traffic complaints and summons issued under the authority of the officer or authority; and
(2) shall prepare and submit the records and reports relating to the traffic complaints in the manner and at the time prescribed by both the state examiner of the state board of accounts and the bureau.
[Pre-1991 Recodification Citation: 9-4-7-4.]
As added by P.L.2-1991, SEC.18. Amended by P.L.93-1991, SEC.2; P.L.1-2001, SEC.8; P.L.184-2007, SEC.59; P.L.206-2007, SEC.7.