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Driver/Vehicle Owner and Notice of Violation Information (NOV) (To be provided by requestor)Date: __________________________Name (Typed or Printed): ________________________________________ __________________________Mailing Address: ________________________________________ __________________________________ ________________________________________ __________________________________City: ________________________________________ _________ State: __________ Zip: _____________Telephone Number: ____________________________________ Fax: ______________________________E-mail: ________________________________________ ________________________________________ _NOV Number: ________________________________________ ___________________________________NOV Violation Date: _______________________________________A gency/Issuing Authority: Jacksonville Sheriff's Office Issuing Officer/Agent Name: ________________________________________ _______________________Badge #: ___________________________Local Court or Hearing Officer Information (To be provided by local authority)Mail to: City Of Jacksonville Traffic Safety ProgramHearing location: TBDKeep a copy of this request for your records********************************* **************************************** ***THIS PAGE OF THE DOCUMENT MUST BE INCLUDED WITH THE AFFIDAVIT ON THE NEXT PAGE!
Affidavit Requesting Hearing and Forfeiting Ability to Contest Delivery I (Name) do hereby request a formal hearing
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