Ill. Admin. Code tit. 92, pt. 450, subpt. F, app A
C/C No. 1753
#1 COMPLAINT
VEHICLE INSPECTION COPY
Hearing Docket No. ______________________
State of Illinois
County of _________________________________________________________________
City or Township of __________________________________________________________
People of the State of Illinois, Plaintiff v.
Name _____________________________________________________________________
Defendant Certified Mechanic Owner/Operator
Lane Name _________________________________________________________________
Address ____________________________________________________________________
City & State __________________________________________________________________
Veh. Test. Station No. ___________________________________________________________
Certified Mechanic Permit No. ______________________________________________________
The undersigned says that on ___________________/________________/____________________
Month Day Year
at ___________________ a.m./p.m. defendant did unlawfully:
Violate Section _______ of the Illinois Vehicle Code
in that he: _____________________________________________
Violate Section ___________________of the Illinois Rules & Regulations Inspection_________
Manual in that he: ______________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________Dated________________ /________________/__________________
Month Day Year
Inspector's Signature I.D. Number
If you choose to appear to answer to the above charges, report to:
______________________________________________________________________
on ________________ /________________/__________________ at _______ a.m./p.m.
Month Day Year
In the event I fail to appear, I hereby consent to the entry of an exparte judgment against me and assessment of whatever fines or determination may be assessed against me.
Signature______________________
Title _________________
Ill. Admin. Code tit. 92, pt. 450, subpt. F, app A