PLEA BY MAIL - NOT TO BE USED FOR SPEEDING VIOLATIONS
OR MISDEMEANORS
PLEA OF GUILTY
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Instructions to person charged: Submit this form to Traffic
Violations Bureau, Municipal Building, Erie Boulevard, Canajoharie,
New York 13317, by registered or certified mail, return receipt requested,
or by first-class mail ACCOMPANIED BY RECORD OF CONVICTION STUB (New
York State license only).
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This form may not be used for misdemeanors or for speeding violations
or for a third or subsequent parking or other violation in a twelve-month
period. If the Bureau denies this application, you will be notified
to appear.
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TO: Traffic Violations Bureau, Village of Canajoharie: I, _________________________
residing at ______________________ have been charged with the violation
as specified on the reverse of this application. I acknowledge receipt
of the warning printed in red on the reverse of the application, and
I waive arraignment in open court and the aid of counsel. I plead
guilty to the offense as charged and elect and request that this charge
be disposed of and fine or penalty fixed by the Traffic Violations
Bureau. During the last 12 months, I have been convicted of those
violations marked on my attached conviction stub and of the additional
violations noted below.
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I make the following statement of explanation (optional)
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All statements are made under penalty of perjury:
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Date:
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Signed:
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