ARIZONA TRAFFIC TICKET AND COMPLAINT Report Number Complaint/Citation No.
Social Security Number Military Accident
No Accident Accident Without Injury/Fatality Accident With Injury/Fatality Driver's License #
State
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Endorsements
M H N P T X D DEFENDANT First Name
Middle Initial
Last Name
Cell Phone
Residential Address City State/Country Zip Code
SEX WEIGHT HEIGHT EYES HAIR ORIGIN Date of Birth
(MM/DD/YYYY) RESTRICTIONS ON Date
(MM/DD/YYYY) TIME OF DAY SPEED APROX. POSTED R & P SECTIONS 1/A
2/B
3/C
4/D
5/E
YOU MUST APPEAR AT Court #/Name
AT THE DATE INDICATED OR EXTENSION DATE
(MM/DD/YYYY) Your Email Address
Class Preference
Select One Cottonwood - Wednesday 5:00 pm (When Available) Prescott - Thursday 5:00 pm

Traffic Survival School Registration First Name
Last Name
Driver's License #
Date of Birth
MVD Case Number OR
MVD Withdrawal Number OR
MVD Customer Number
Cell Phone
Your Email Address
Class Preference
Select One Cottonwood Prescott